Provider Demographics
NPI:1619066750
Name:WEBSTER, J. R. CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:J. R. CRAIG
Middle Name:
Last Name:WEBSTER
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:PO BOX Y
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0983
Mailing Address - Country:US
Mailing Address - Phone:509-826-1260
Mailing Address - Fax:509-826-3614
Practice Address - Street 1:204 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-0983
Practice Address - Country:US
Practice Address - Phone:509-826-1260
Practice Address - Fax:509-826-3614
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000044121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice