Healthcare Provider Details

I. General information

NPI: 1053467399
Provider Name (Legal Business Name): CRAIG ALLEN RECHKEMMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 S CAMPBELL AVE SUITE 120
SPRINGFIELD MO
65810-1724
US

IV. Provider business mailing address

3409 N FENWICKE ST
OZARK MO
65721-7997
US

V. Phone/Fax

Practice location:
  • Phone: 417-300-9424
  • Fax:
Mailing address:
  • Phone: 417-234-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3693
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2002012097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: