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DR. MICHAEL RAYMOND CRADDOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5901
(505) 846-3200
Mailing address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-1823
(719) 502-0612

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
DD5009
NM
122300000X
Dentist
DEN.00009325
CO
1223G0001X
General Practice Dentistry
14481
TX
1223P0700X
Prosthodontics
14481
TX
1223P0700X
Prosthodontics
Primary
DEN.00009325
CO

Other

Enumeration date
05/05/2006
Last updated
04/14/2021
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