Provider Demographics
NPI:1679623110
Name:CRAIG, JR., THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:CRAIG, JR.
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 1:4283 RALEIGH MILLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2207
Mailing Address - Country:US
Mailing Address - Phone:901-372-1221
Mailing Address - Fax:901-372-1251
Practice Address - Street 1:4283 RALEIGH MILLINGTON RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2207
Practice Address - Country:US
Practice Address - Phone:901-372-1221
Practice Address - Fax:901-372-1251
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice