Provider Demographics
NPI:1811448277
Name:G BRYON CRAIG PLLC
Entity type:Organization
Organization Name:G BRYON CRAIG PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:BRYON
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-882-2444
Mailing Address - Street 1:15955 NE 85TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-882-2444
Mailing Address - Fax:425-867-0444
Practice Address - Street 1:15955 NE 85TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3550
Practice Address - Country:US
Practice Address - Phone:425-882-2444
Practice Address - Fax:425-867-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10472302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization