MEDICARE: DR. THOMAS ELLIOT KRUPA D.D.S.

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		IL

General Provider Information

NPI Number	:	1528254331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ELLIOT KRUPA D.D.S.

Provider Business Mailing Address
First Line	:	8240 WOLF RD
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1084
Country	:	US
Telephone Number	:	708-839-5529
Fax Number	:	708-839-4356

Provider Business Practice Location Address
First Line	:	8240 WOLF RD
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1084
Country	:	US
Telephone Number	:	708-839-5529
Fax Number	:	708-839-4356

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

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	09/15/2007

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