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General NPI Number Information
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NPI Number | 1720152192
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Entity Type | Individual
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Provider Name | JOHN ELLIS CRAIG DDS
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 480 W LOWDER ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2664
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Country | US
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Telephone | 904-259-6291
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Fax | 904-259-4761
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Provider Business Mailing Address
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Address Line | 6223 SAUTERNE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32210-7728
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Country | US
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Telephone | 904-771-0568
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Fax | 904-771-3468
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 7228
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License Number State | FL
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