Provider Demographics
NPI:1619136702
Name:RATZLAFF, CRAIG DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:BLDG 1020 STE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-722-7100
Mailing Address - Fax:316-722-5180
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:BLDG 1020 STE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-722-7100
Practice Address - Fax:316-722-5180
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS68321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics