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General NPI Number Information
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NPI Number | 1396134862
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Entity Type | Organization
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Legal Business Name | MACKENZIE H. CRAIK, DDS, PLLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 2014 S HOWARD ST STE A
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City | WALLA WALLA
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State | WA
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Zip | 99362-4532
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Country | US
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Telephone | 509-525-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 S HOWARD ST STE A
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City | WALLA WALLA
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State | WA
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Zip | 99362-4532
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Country | US
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Telephone | 509-525-7336
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MACKENZIE CRAIK
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Credential | D.D.S.
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Telephone | 206-683-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60459114
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License Number State | WA
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