Healthcare Provider Details

I. General information

NPI: 1912017336
Provider Name (Legal Business Name): MICHAEL BRADY KRZEMIEN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LINDEN OAKS STE 200
ROCHESTER NY
14625-2841
US

IV. Provider business mailing address

200 LINDEN OAKS STE 200
ROCHESTER NY
14625-2841
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-1492
  • Fax:
Mailing address:
  • Phone: 585-442-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number052048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: