Healthcare Provider Details

I. General information

NPI: 1407226459
Provider Name (Legal Business Name): RICHARD KRAWCZYK DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 ALTERNATE 19
DUNEDIN FL
34698-1516
US

IV. Provider business mailing address

3310 ALTERNATE 19
DUNEDIN FL
34698-1516
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-0589
  • Fax:
Mailing address:
  • Phone: 727-785-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10780
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD KRAWCZYK
Title or Position: OWNER
Credential: DDS
Phone: 727-785-0589