Provider Demographics
NPI:1316157639
Name:HEALY, CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:HEALY
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 1:240 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1971
Mailing Address - Country:US
Mailing Address - Phone:415-435-1057
Mailing Address - Fax:415-435-0818
Practice Address - Street 1:1500 TARA HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2577
Practice Address - Country:US
Practice Address - Phone:510-724-7575
Practice Address - Fax:510-724-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADW0347101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice