Healthcare Provider Details

I. General information

NPI: 1619024452
Provider Name (Legal Business Name): DAVID J CRAITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S MAIN ST
ONSTED MI
49265-9763
US

IV. Provider business mailing address

257 S MAIN ST
ONSTED MI
49265-9763
US

V. Phone/Fax

Practice location:
  • Phone: 517-467-2111
  • Fax: 517-467-2112
Mailing address:
  • Phone: 517-467-2111
  • Fax: 517-467-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: