Healthcare Provider Details

I. General information

NPI: 1679546543
Provider Name (Legal Business Name): FRANK A KRUSE III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5983 HIGHWAY 53 E HIGHTOWER PLACE
DAWSONVILLE GA
30534-9513
US

IV. Provider business mailing address

5983 HIGHWAY 53 E HIGHTOWER PLACE
DAWSONVILLE GA
30534-6293
US

V. Phone/Fax

Practice location:
  • Phone: 706-216-4402
  • Fax: 706-216-4404
Mailing address:
  • Phone: 706-216-4402
  • Fax: 706-216-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010904
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: