MEDICARE: KOLE KRASNIQI DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1114191418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLE KRASNIQI DDS, PC

Provider Business Mailing Address
First Line	:	3918 SHERMAN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3648
Country	:	US
Telephone Number	:	816-786-1132
Fax Number	:	816-817-0504

Provider Business Practice Location Address
First Line	:	3918 SHERMAN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3648
Country	:	US
Telephone Number	:	816-786-1132
Fax Number	:	816-817-0504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KOLE KRASNIQI
Credential	:	DDS
Telephone Number	:	816-786-1132

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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