Healthcare Provider Details

I. General information

NPI: 1972564847
Provider Name (Legal Business Name): FRANK J KRATOCHVIL III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12254 SW GARDEN PL
TIGARD OR
97223-8246
US

IV. Provider business mailing address

PO BOX 230457
TIGARD OR
97281-0457
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-7300
  • Fax: 503-245-8219
Mailing address:
  • Phone: 503-906-7300
  • Fax: 503-245-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD7231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: