MEDICARE: DR. NELSON CHARLES KRUM JR. DDS

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	4499	CO
2	1223G0001X	General Practice Dentistry	121	MP

General Provider Information

NPI Number	:	1316948136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON CHARLES KRUM JR. DDS

Provider Business Mailing Address
First Line	:	5050 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918
Country	:	US
Telephone Number	:	719-260-6093
Fax Number	:	719-260-2339

Provider Business Practice Location Address
First Line	:	WAKINS BLDG. 125 MIDDLE RD. GUALO RAI
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950
Country	:	US
Telephone Number	:	670-234-4040
Fax Number	:	670-488-1044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/28/2020

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