Healthcare Provider Details

I. General information

NPI: 1972662906
Provider Name (Legal Business Name): TRISHA ANN KRAUSE DMD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 B PATTERSON AVE
RICHMOND VA
23226
US

IV. Provider business mailing address

3905 CARY STREET ROAD
RICHMOND VA
23221
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-0400
  • Fax: 804-285-0303
Mailing address:
  • Phone: 804-358-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401411549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: