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General NPI Number Information
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NPI Number | 1154004273
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Entity Type | Organization
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Legal Business Name | DR. BRANDON KRATZ DDS LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 11710 OLD BALLAS RD STE 100
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City | CREVE COEUR
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State | MO
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Zip | 63141-7076
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Country | US
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Telephone | 314-991-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 STONEY TERRACE DR
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City | BALLWIN
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State | MO
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Zip | 63021-7782
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Country | US
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Telephone | 417-988-2424
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRANDON KRATZ
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Credential | DDS
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Telephone | 417-988-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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