Organization
METRO ORAL & MAXILLOFACIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG D SCHMIDTKE DDS (ORAL SURGEON/OWNER)
(334) 699-5555
Entity
Organization
Contact information
Practice address
100 METRO DR, DOTHAN, AL 36303-1985
(334) 699-5555
Mailing address
100 METRO DR, DOTHAN, AL 36303-1985
(334) 699-5555
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
5391C
AL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5391C
AL
1223X0008X
Oral and Maxillofacial Radiology Dentistry
5391C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51529237
BCBS OF ALABAMA
AL
01
—
5391C
ALABAMA LICENSE #
AL
01
—
755031
UNITED CONCORDIA
AL
Enumeration date
03/18/2008
Last updated
03/18/2008
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