Provider Demographics
NPI:1578570115
Name:RATHJEN, CRAIG LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LAWRENCE
Last Name:RATHJEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 COUNTY ROAD 10 NE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2373
Mailing Address - Country:US
Mailing Address - Phone:763-780-1300
Mailing Address - Fax:763-785-7818
Practice Address - Street 1:607 COUNTY ROAD 10 NE
Practice Address - Street 2:SUITE #100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2373
Practice Address - Country:US
Practice Address - Phone:763-780-1300
Practice Address - Fax:763-785-7818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist