Healthcare Provider Details

I. General information

NPI: 1790884393
Provider Name (Legal Business Name): CRAIG D MCDOW DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 1130
SAN FRANCISCO CA
94108-3995
US

IV. Provider business mailing address

450 SUTTER ST RM 1130
SAN FRANCISCO CA
94108-3995
US

V. Phone/Fax

Practice location:
  • Phone: 415-318-1818
  • Fax: 415-989-1131
Mailing address:
  • Phone: 415-318-1818
  • Fax: 415-989-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number37139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: