Provider Demographics
NPI:1720381981
Name:ATCHISON, CRAIG A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:ATCHISON
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 1:4203 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3309
Mailing Address - Country:US
Mailing Address - Phone:512-371-7239
Mailing Address - Fax:512-371-9232
Practice Address - Street 1:4203 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3309
Practice Address - Country:US
Practice Address - Phone:512-371-7239
Practice Address - Fax:512-371-9232
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist