Provider Demographics
NPI:1700243037
Name:PETER T CRACCHIOLO JR DDS PC
Entity Type:Organization
Organization Name:PETER T CRACCHIOLO JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRACCHIOLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-570-8375
Mailing Address - Street 1:417 OAK RUN CT
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31700 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-3407
Practice Address - Country:US
Practice Address - Phone:248-433-6000
Practice Address - Fax:248-433-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty