Healthcare Provider Details

I. General information

NPI: 1366409799
Provider Name (Legal Business Name): STEVEN M KRAKORA D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 N FRANKLIN DR SUITE 2
WASHINGTON PA
15301-5892
US

IV. Provider business mailing address

2112 N FRANKLIN DR SUITE 2
WASHINGTON PA
15301-5892
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-0579
  • Fax: 724-223-0597
Mailing address:
  • Phone: 724-223-0579
  • Fax: 724-223-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS030642L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDA031589
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS030642L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: