Healthcare Provider Details

I. General information

NPI: 1992852610
Provider Name (Legal Business Name): BRIAN S KROST D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 STATE ROUTE 35
OCEAN NJ
07712-4043
US

IV. Provider business mailing address

313 CRIMSON CIR
OAKHURST NJ
07755-1658
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-8700
  • Fax: 732-531-8775
Mailing address:
  • Phone: 732-229-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI017253
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: