Provider Demographics
NPI:1386156446
Name:CRAFT, CHARLES FREDERICK (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:CRAFT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DHHS NEBRASKA OFFICE OF ORAL HEALTH AND DENTISTRY
Mailing Address - Street 2:301 CENTENNIAL MALL SOUTH
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68509-5026
Mailing Address - Country:US
Mailing Address - Phone:402-471-4599
Mailing Address - Fax:402-471-6446
Practice Address - Street 1:301 CENTENNIAL MALL S
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2529
Practice Address - Country:US
Practice Address - Phone:402-471-4599
Practice Address - Fax:402-471-6446
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice