=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033258678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. CRAIG J. CHRISTIAN, A PROFESSIONAL DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 01/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 LIGHTHOUSE AVE
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-375-4942
-----------------------------------------------------
Fax | 831-375-2960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 180
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-0180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-375-4942
-----------------------------------------------------
Fax | 831-375-2960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. CRAIG JAMES CHRISTIAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 831-375-4942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 29993
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------