Provider Demographics
NPI:1285605782
Name:DR CRAIG W BYERS LTD
Entity type:Organization
Organization Name:DR CRAIG W BYERS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-257-1221
Mailing Address - Street 1:2457 N MAYFAIR RD
Mailing Address - Street 2:# 102 DR CRAIG W BYERS
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1405
Mailing Address - Country:US
Mailing Address - Phone:414-257-1221
Mailing Address - Fax:414-257-1289
Practice Address - Street 1:2457 N MAYFAIR RD
Practice Address - Street 2:# 102 DR CRAIG W BYERS
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1405
Practice Address - Country:US
Practice Address - Phone:414-257-1221
Practice Address - Fax:414-257-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50007S4 0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33537200Medicaid
T61616Medicare UPIN
WI33537200Medicaid