Provider Demographics
NPI:1306877840
Name:MCCRAITH, GREGORY HUGHES (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:HUGHES
Last Name:MCCRAITH
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 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1532
Mailing Address - Country:US
Mailing Address - Phone:716-375-7300
Mailing Address - Fax:716-375-7311
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1532
Practice Address - Country:US
Practice Address - Phone:716-375-7300
Practice Address - Fax:716-375-7311
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC039508-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice