Provider Demographics
NPI:1023289998
Name:METRO ORAL & MAXILLOFACIAL
Entity type:Organization
Organization Name:METRO ORAL & MAXILLOFACIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHMIDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:334-699-5555
Mailing Address - Street 1:100 METRO DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1985
Mailing Address - Country:US
Mailing Address - Phone:334-699-5555
Mailing Address - Fax:
Practice Address - Street 1:100 METRO DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1985
Practice Address - Country:US
Practice Address - Phone:334-699-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5391C1223P0106X, 1223X0008X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL755031OtherUNITED CONCORDIA
AL51529237OtherBCBS OF ALABAMA
AL5391COtherALABAMA LICENSE #