Provider Demographics
NPI:1629023643
Name:SHIMIZU, CRAIG R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:SHIMIZU
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 1:5682 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2916
Mailing Address - Country:US
Mailing Address - Phone:440-449-9111
Mailing Address - Fax:440-461-0007
Practice Address - Street 1:5682 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2916
Practice Address - Country:US
Practice Address - Phone:440-449-9111
Practice Address - Fax:440-461-0007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice