Provider Demographics
NPI:1174855415
Name:CRAIG A. ISRAEL, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CRAIG A. ISRAEL, DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO OPERATIONS AND RELATIONSHIPS
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:310-713-7553
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 1117
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-393-0465
Mailing Address - Fax:
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 1117
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-393-0465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35507261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental