Healthcare Provider Details

I. General information

NPI: 1972817542
Provider Name (Legal Business Name): PRESTON MACNAIR CRIDDLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8955 WOOD RD BLDG 1
BETHESDA MD
20889-5611
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1495
  • Fax:
Mailing address:
  • Phone: 301-295-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number60036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: