Provider Demographics
NPI:1083781538
Name:NEAL, CRAIG E (MD DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:NEAL
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13131 120TH AVE NE
Mailing Address - Street 2:#A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-825-7575
Mailing Address - Fax:425-825-5615
Practice Address - Street 1:13131 120TH AVE NE
Practice Address - Street 2:#A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-825-7575
Practice Address - Fax:425-825-5615
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000072891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT60941Medicare UPIN