Healthcare Provider Details

I. General information

NPI: 1750549663
Provider Name (Legal Business Name): RONEN KRAUSZ D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HARVARD ST FL 2
BROOKLINE MA
02446-5071
US

IV. Provider business mailing address

209 HARVARD ST FL 2
BROOKLINE MA
02446-5071
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-5437
  • Fax:
Mailing address:
  • Phone: 617-731-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number57052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN22004
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: