Healthcare Provider Details

I. General information

NPI: 1447385265
Provider Name (Legal Business Name): MERAV KROLL FRUCHTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N MAIN ST
FREEPORT NY
11520-1229
US

IV. Provider business mailing address

6847 147TH ST
FLUSHING NY
11367-1345
US

V. Phone/Fax

Practice location:
  • Phone: 516-379-5500
  • Fax:
Mailing address:
  • Phone: 718-520-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number045599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: