Provider Demographics
NPI:1285937557
Name:BYERS, CRAIG WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:BYERS
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 1:2457 NORTH MAYFAIR ROAD
Mailing Address - Street 2:SUITE 102
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 NORTH MAYFAIR ROAD
Practice Address - Street 2:SUITE 102
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
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000754-0151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33537200Medicaid
T61616Medicare UPIN
WI33537200Medicaid