Provider Demographics
NPI:1194950063
Name:ROBERT A. CRAIG, DDS, MS, PC
Entity type:Organization
Organization Name:ROBERT A. CRAIG, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-926-9224
Mailing Address - Street 1:1120 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8951
Mailing Address - Country:US
Mailing Address - Phone:303-926-9224
Mailing Address - Fax:303-926-9378
Practice Address - Street 1:1120 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE #201
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8951
Practice Address - Country:US
Practice Address - Phone:303-926-9224
Practice Address - Fax:303-926-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57674841Medicaid