Provider Demographics
NPI:1306969316
Name:CANCROFT, JOHN EVERETT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:CANCROFT
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 1:15 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1011
Mailing Address - Country:US
Mailing Address - Phone:631-261-1839
Mailing Address - Fax:
Practice Address - Street 1:15 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1011
Practice Address - Country:US
Practice Address - Phone:631-261-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041375-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist