Provider Demographics
NPI:1861605875
Name:MANZO-CRADDOCK, PATRICIA J (DDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:MANZO-CRADDOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10816 KINSMAN RD.
Mailing Address - Street 2:P.O. BOX 342
Mailing Address - City:NEWBURY
Mailing Address - State:OH
Mailing Address - Zip Code:44065
Mailing Address - Country:US
Mailing Address - Phone:440-564-5387
Mailing Address - Fax:440-564-5419
Practice Address - Street 1:10816 KINSMAN RD.
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065
Practice Address - Country:US
Practice Address - Phone:440-564-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist