Provider Demographics
NPI:1194383752
Name:TESTERMAN, CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:TESTERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:TESTERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 2980
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-2980
Mailing Address - Country:US
Mailing Address - Phone:505-281-3406
Mailing Address - Fax:505-224-8737
Practice Address - Street 1:7 MUNICIPAL WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-7086
Practice Address - Country:US
Practice Address - Phone:505-281-3406
Practice Address - Fax:505-224-8737
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD5101122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist