Healthcare Provider Details

I. General information

NPI: 1780620310
Provider Name (Legal Business Name): GREGORY KRANER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 WOODSON RD
OVERLAND MO
63114-5423
US

IV. Provider business mailing address

1348 CARRIAGE CROSSING LN
CHESTERFIELD MO
63005-4452
US

V. Phone/Fax

Practice location:
  • Phone: 314-427-2424
  • Fax: 314-427-7787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12088
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: