Healthcare Provider Details

I. General information

NPI: 1053650804
Provider Name (Legal Business Name): CRAIG C. CHRISTIAN, DDS,PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 VAN GIESEN ST
RICHLAND WA
99354-2616
US

IV. Provider business mailing address

225 VAN GIESEN ST
RICHLAND WA
99354-2616
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-3574
  • Fax: 509-943-1182
Mailing address:
  • Phone: 509-946-3574
  • Fax: 509-943-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CRAIG C CHRISTIAN
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 509-946-3574