Provider Demographics
NPI:1578863494
Name:CRAYDEN DENNARD, D.D.S. & RICARDO LUCIO, D.D.S., PLLC
Entity Type:Organization
Organization Name:CRAYDEN DENNARD, D.D.S. & RICARDO LUCIO, D.D.S., PLLC
Other - Org Name:DENTAL ARTS OF BAY CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CRAYDEN
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-245-4746
Mailing Address - Street 1:4040 AVE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414
Mailing Address - Country:US
Mailing Address - Phone:979-245-4746
Mailing Address - Fax:979-244-4746
Practice Address - Street 1:4040 AVE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414
Practice Address - Country:US
Practice Address - Phone:979-245-4746
Practice Address - Fax:979-244-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty