Provider Demographics
NPI:1053650804
Name:CRAIG C. CHRISTIAN, DDS,PS
Entity Type:Organization
Organization Name:CRAIG C. CHRISTIAN, DDS,PS
Other - Org Name:RIVERSTONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-946-3574
Mailing Address - Street 1:225 VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2616
Mailing Address - Country:US
Mailing Address - Phone:509-946-3574
Mailing Address - Fax:509-943-1182
Practice Address - Street 1:225 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2616
Practice Address - Country:US
Practice Address - Phone:509-946-3574
Practice Address - Fax:509-943-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6972550001Medicare NSC