Provider Demographics
NPI:1538615158
Name:J.R. CRAIG WEBSTER D.D.S.
Entity type:Organization
Organization Name:J.R. CRAIG WEBSTER D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J. R.
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WEBSTER D D S
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-826-1260
Mailing Address - Street 1:PO BOX Y
Mailing Address - Street 2:204 WEST 1ST STR.
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0983
Mailing Address - Country:US
Mailing Address - Phone:509-826-1260
Mailing Address - Fax:
Practice Address - Street 1:204 WEST 1ST. STREET
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-1260
Practice Address - Fax:509-826-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4412305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization