Provider Demographics
NPI:1952408536
Name:PROCTOR, CRAIG R (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:PROCTOR
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 1:2936 HIGHLAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3582
Mailing Address - Country:US
Mailing Address - Phone:801-486-2800
Mailing Address - Fax:801-485-8188
Practice Address - Street 1:2936 HIGHLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3582
Practice Address - Country:US
Practice Address - Phone:801-486-2800
Practice Address - Fax:801-485-8188
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143618-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice