Healthcare Provider Details

I. General information

NPI: 1821030966
Provider Name (Legal Business Name): PAUL ROBERT KRASNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S ROLAND ST
POTTSTOWN PA
19464-5836
US

IV. Provider business mailing address

18 S ROLAND ST
POTTSTOWN PA
19464-5836
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-4646
  • Fax: 610-327-3234
Mailing address:
  • Phone: 610-327-4646
  • Fax: 610-327-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberAK1974713
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: