Healthcare Provider Details

I. General information

NPI: 1467550400
Provider Name (Legal Business Name): CRAIG D SCHMIDTKE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 METRO DR
DOTHAN AL
36303-1985
US

IV. Provider business mailing address

100 METRO DR
DOTHAN AL
36303-1985
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-5555
  • Fax: 334-699-5558
Mailing address:
  • Phone: 334-699-5555
  • Fax: 334-699-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5391C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5391C
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number5391C
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51529237
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS OF AL PROVIDER #I
# 2
Identifier5391C
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerALABAMA LICENSE #
# 3
Identifier755031
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerUNITED CONCORDIA PROVI #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: