Provider Demographics
NPI:1093842601
Name:BILLY C CRISWELL INC
Entity Type:Organization
Organization Name:BILLY C CRISWELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BILLY C CRISWELL INC
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRL
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:CRISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-474-7076
Mailing Address - Street 1:1607 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-4735
Mailing Address - Country:US
Mailing Address - Phone:479-474-7076
Mailing Address - Fax:479-471-1868
Practice Address - Street 1:1607 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4735
Practice Address - Country:US
Practice Address - Phone:479-474-7076
Practice Address - Fax:479-471-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty