Healthcare Provider Details

I. General information

NPI: 1205455052
Provider Name (Legal Business Name): RICHARD MATTHEW KRALIK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 E GRANT RD STE 121
TUCSON AZ
85712-2763
US

IV. Provider business mailing address

3300 N PASEO DE LOS RIOS APT 24205
TUCSON AZ
85712-6616
US

V. Phone/Fax

Practice location:
  • Phone: 520-276-0568
  • Fax:
Mailing address:
  • Phone: 470-590-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012935
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: