Basic Information
| Provider Information | |||||||||
| NPI: | 1699077800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 SW CENTER ST | ||||||||
| Address2: | |||||||||
| City: | FAISON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283418820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102990991 | ||||||||
| FaxNumber: | 9102990995 | ||||||||
| Practice Location | |||||||||
| Address1: | 104C ADAIR DR | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275304516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196484437 | ||||||||
| FaxNumber: | 8556261330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 150818 | NC | N | Dental Providers | Dentist | General Practice | 1223D0001X | 9090 | NC | Y | Dental Providers | Dentist | Dental Public Health |
No ID Information.