Provider Demographics
NPI:1053467399
Name:RECHKEMMER, CRAIG ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:RECHKEMMER
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 1:3409 N FENWICKE ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7997
Mailing Address - Country:US
Mailing Address - Phone:417-234-2462
Mailing Address - Fax:
Practice Address - Street 1:4728 S CAMPBELL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1724
Practice Address - Country:US
Practice Address - Phone:417-300-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36931223D0001X
MO2002012097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO405744707Medicaid
MO2002012097OtherMISSOURI DENTAL BOARD
AR3693OtherARKANSAS DENTAL BOARD