Provider Demographics
NPI:1427029446
Name:SCHLIE, CRAIG ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:SCHLIE
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 1:10343 SUNDANCE RD
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9773
Mailing Address - Country:US
Mailing Address - Phone:530-549-3256
Mailing Address - Fax:
Practice Address - Street 1:405 SOUTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2101
Practice Address - Country:US
Practice Address - Phone:530-244-6054
Practice Address - Fax:530-244-6056
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273661223G0001X
NE59951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB27366-02Medicaid