Provider Demographics
NPI:1205965662
Name:STANNEBEIN, CRAIG EUGENE (DMD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EUGENE
Last Name:STANNEBEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 BROADWATER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4778
Mailing Address - Country:US
Mailing Address - Phone:406-652-8782
Mailing Address - Fax:406-652-8724
Practice Address - Street 1:2132 BROADWATER AVE STE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4778
Practice Address - Country:US
Practice Address - Phone:406-652-8782
Practice Address - Fax:406-652-8724
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12-1160Medicaid
MT55-11145OtherCHIP