MEDICARE: DR. JOHN TK KRAEMER DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN10000054	MA

General Provider Information

NPI Number	:	1871298372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN TK KRAEMER DMD

Provider Business Mailing Address
First Line	:	12 REARDON ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-2581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 OLD WEST CENTRAL ST STE 201
Second Line	:
City	:	FRANKLIN
State	:	MA
Zip	:	02038-3051
Country	:	US
Telephone Number	:	508-541-7400
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	05/15/2024

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