Healthcare Provider Details

I. General information

NPI: 1285937557
Provider Name (Legal Business Name): CRAIG WILLIAM BYERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 NORTH MAYFAIR ROAD SUITE 102
WAUWATOSA WI
53226-1405
US

IV. Provider business mailing address

2457 NORTH MAYFAIR ROAD SUITE 102
WAUWATOSA WI
53226-1405
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-1221
  • Fax: 414-257-1289
Mailing address:
  • Phone: 414-257-1221
  • Fax: 414-257-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5000754-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: