MEDICARE: KRONQUIST DENTAL PARTNERSHIP

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	122300000X	Dentist

General Provider Information

NPI Number	:	1518760065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRONQUIST DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 MARINE AVE STE A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662-1289
Country	:	US
Telephone Number	:	949-673-7820
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. AMANDA RAE KRONQUIST
Credential	:	DDS, MS
Telephone Number	:	949-673-7820

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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