Healthcare Provider Details

I. General information

NPI: 1043306277
Provider Name (Legal Business Name): CRAIG GLEN SHADINGER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 TAYLOR RD SE
OWENS CROSS ROADS AL
35763-9498
US

IV. Provider business mailing address

54 TAYLOR RD SE
OWENS CROSS ROADS AL
35763-9498
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-0418
  • Fax:
Mailing address:
  • Phone: 256-536-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5285
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: