Healthcare Provider Details

I. General information

NPI: 1144259581
Provider Name (Legal Business Name): ANDREW J KRAMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S PARK ST 506
MADISON WI
53715-1348
US

IV. Provider business mailing address

20 S. PARK ST. 506
MADISON WI
53715
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1961
  • Fax: 608-256-1501
Mailing address:
  • Phone: 608-256-1961
  • Fax: 608-256-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5986
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: