Healthcare Provider Details

I. General information

NPI: 1730169087
Provider Name (Legal Business Name): CRAIG MATTHEW NEITZKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE.
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4355 REDWOOD RD
FORT MEADE MD
20755-2206
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1550
  • Fax:
Mailing address:
  • Phone: 410-674-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1345663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: