MEDICARE: DR. RONALD CRAIG ENG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00006090	WA

General Provider Information

NPI Number	:	1316152739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD CRAIG ENG DDS

Provider Business Mailing Address
First Line	:	9308 S 237TH PL
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-2935
Country	:	US
Telephone Number	:	253-850-6163
Fax Number	:	206-932-7088

Provider Business Practice Location Address
First Line	:	9639 28TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-4101
Country	:	US
Telephone Number	:	206-935-6060
Fax Number	:	206-932-7088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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