=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235286428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRANTZ DENTAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 10/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 CEDAR GROVE LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-469-8083
-----------------------------------------------------
Fax | 732-469-8393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CEDAR GROVE LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-469-8083
-----------------------------------------------------
Fax | 732-469-8393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL B. KRANTZ
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 732-469-8083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 11022
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------