Provider Demographics
NPI:1194706523
Name:PRESTON, MICHAEL CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:PRESTON
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 1:20600 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5432
Mailing Address - Country:US
Mailing Address - Phone:510-581-4124
Mailing Address - Fax:
Practice Address - Street 1:20600 LAKE CHABOT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5432
Practice Address - Country:US
Practice Address - Phone:510-581-4124
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist