Healthcare Provider Details

I. General information

NPI: 1811211485
Provider Name (Legal Business Name): JOSEPH J. KRUPA, III, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 MEDICAL CENTER DRIVE
WILMINGTON NC
28401-7506
US

IV. Provider business mailing address

1510 MEDICAL CENTER DRIVE
WILMINGTON NC
28401-7506
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-1555
  • Fax: 910-251-1721
Mailing address:
  • Phone: 910-762-1555
  • Fax: 910-251-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2847
License Number StateNC

VIII. Authorized Official

Name: JOSEPH J KRUPA III
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 910-762-1555