Healthcare Provider Details

I. General information

NPI: 1538721444
Provider Name (Legal Business Name): BRANDON KRATZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 PAXTON AVE STE 12A
CINCINNATI OH
45209-2399
US

IV. Provider business mailing address

3802 PAXTON AVE STE 12A
CINCINNATI OH
45209-2399
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-3352
  • Fax:
Mailing address:
  • Phone: 417-988-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026085
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2019020710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: