MEDICARE: EDWIN J KREJCI DMD 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	122300000X	Dentist	DS019650L	PA

General Provider Information

NPI Number	:	1548370349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWIN J KREJCI DMD PC

Provider Business Mailing Address
First Line	:	2039 LYCOMING CREEK ROAD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701
Country	:	US
Telephone Number	:	570-323-2399
Fax Number	:	570-323-2441

Provider Business Practice Location Address
First Line	:	2039 LYCOMING CREEK ROAD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701
Country	:	US
Telephone Number	:	570-323-2399
Fax Number	:	570-323-2441

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWIN JAMES KREJCI JR.
Credential	:	DMD
Telephone Number	:	570-323-2399

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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