Provider Demographics
NPI:1780983957
Name:CRADOC, WILLIE III (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:
Last Name:CRADOC
Suffix:III
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 1:2272 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5614 W GRAND PKWY S
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5820
Practice Address - Country:US
Practice Address - Phone:310-909-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist