Provider Demographics
NPI:1366506503
Name:CHRISTIAN, CRAIG C (DDS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:C
Last Name:CHRISTIAN
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 1:1290 GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9510
Mailing Address - Country:US
Mailing Address - Phone:509-627-2500
Mailing Address - Fax:509-943-1182
Practice Address - Street 1:225 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2616
Practice Address - Country:US
Practice Address - Phone:509-946-3574
Practice Address - Fax:509-943-1182
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5020607Medicaid