Healthcare Provider Details

I. General information

NPI: 1417948001
Provider Name (Legal Business Name): CRAIG ALLEN FLICKINGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR 88MDG/SGDD
WRIGHT PATTERSON AFB OH
45433-5546
US

IV. Provider business mailing address

832 PEARSON RD
WRIGHT PATTERSON AFB OH
45433-1160
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-9585
  • Fax: 937-656-1130
Mailing address:
  • Phone: 937-879-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901014405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: