Healthcare Provider Details

I. General information

NPI: 1659472322
Provider Name (Legal Business Name): PAUL D. KRUTH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 E MARKET ST
YORK PA
17403-1254
US

IV. Provider business mailing address

1447 E MARKET ST
YORK PA
17403-1254
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-2771
  • Fax: 717-845-5907
Mailing address:
  • Phone: 717-845-2771
  • Fax: 717-845-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS029461L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: