Provider Demographics
NPI:1912098542
Name:CONROW, CRAIG WILLIAM (DSS,MS,FACP)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:CONROW
Suffix:
Gender:M
Credentials:DSS,MS,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73993 HIGHWAY 111
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4034
Mailing Address - Country:US
Mailing Address - Phone:760-776-4688
Mailing Address - Fax:760-776-0079
Practice Address - Street 1:73993 HIGHWAY 111
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4034
Practice Address - Country:US
Practice Address - Phone:760-776-4688
Practice Address - Fax:760-776-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics