Provider Demographics
NPI:1467550400
Name:SCHMIDTKE, CRAIG D (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:SCHMIDTKE
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 1:100 METRO DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1985
Mailing Address - Country:US
Mailing Address - Phone:334-699-5555
Mailing Address - Fax:334-699-5558
Practice Address - Street 1:100 METRO DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1985
Practice Address - Country:US
Practice Address - Phone:334-699-5555
Practice Address - Fax:334-699-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5391C1223P0106X, 1223S0112X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529237OtherBCBS OF AL PROVIDER #I
AL5391COtherALABAMA LICENSE #
AL755031OtherUNITED CONCORDIA PROVI #
ALU75915Medicare UPIN