Healthcare Provider Details

I. General information

NPI: 1205089208
Provider Name (Legal Business Name): CARL WILLIAM MCCRADY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 DISPATCH RD
QUINTON VA
23141
US

IV. Provider business mailing address

P.O. BOX 130
QUINTON VA
23141
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4940
  • Fax: 804-932-8949
Mailing address:
  • Phone: 804-932-4940
  • Fax: 804-932-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401008640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: