Provider Demographics
NPI:1427100171
Name:CRADDOCK, DAVID WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:CRADDOCK
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 1:720 OLIVE WAY
Mailing Address - Street 2:SUITE 835
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1878
Mailing Address - Country:US
Mailing Address - Phone:206-622-2082
Mailing Address - Fax:206-622-7244
Practice Address - Street 1:720 OLIVE WAY
Practice Address - Street 2:SUITE 835
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1878
Practice Address - Country:US
Practice Address - Phone:206-622-2082
Practice Address - Fax:206-622-7244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist