Healthcare Provider Details

I. General information

NPI: 1982593950
Provider Name (Legal Business Name): ERIC KROCHMALNEK DMD, MSC, BSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST STE 13
WORCESTER MA
01610-2478
US

IV. Provider business mailing address

85 GREEN ST # 403
WORCESTER MA
01604-4144
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7700
  • Fax:
Mailing address:
  • Phone: 508-713-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31897
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: