Provider Demographics
NPI:1417025164
Name:CRAIG, GEORGE BRYON (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRYON
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1813
Mailing Address - Country:US
Mailing Address - Phone:360-794-7132
Mailing Address - Fax:360-863-1959
Practice Address - Street 1:455 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1813
Practice Address - Country:US
Practice Address - Phone:360-794-7132
Practice Address - Fax:360-863-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice