Provider Demographics
NPI:1780749556
Name:YODER, CRAIG RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RAYMOND
Last Name:YODER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-0513
Mailing Address - Country:US
Mailing Address - Phone:574-825-1252
Mailing Address - Fax:574-825-9927
Practice Address - Street 1:317 W BRISTOL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-0513
Practice Address - Country:US
Practice Address - Phone:574-825-1252
Practice Address - Fax:574-825-9927
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist