Provider Demographics
NPI:1255667168
Name:J. CRAIG SCASTA, D.D.S., PA
Entity Type:Organization
Organization Name:J. CRAIG SCASTA, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SCASTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-260-2626
Mailing Address - Street 1:1615 BARAK LN STE 2
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3301
Mailing Address - Country:US
Mailing Address - Phone:979-260-2626
Mailing Address - Fax:979-260-2631
Practice Address - Street 1:1615 BARAK LN STE 2
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3301
Practice Address - Country:US
Practice Address - Phone:979-260-2626
Practice Address - Fax:979-260-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty