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General NPI Number Information
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NPI Number | 1386985281
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Entity Type | Individual
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Provider Name | EVAN KRAUSE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 150 RIVER RD SUITE J-2
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City | MONTVILLE
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State | NJ
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Zip | 07045-9441
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Country | US
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Telephone | 973-334-5556
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Fax | 973-331-0134
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Provider Business Mailing Address
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Address Line | 366 GETTYSBURG WAY
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City | LINCOLN PARK
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State | NJ
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Zip | 07035-1837
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Country | US
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Telephone | 201-953-9889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02547000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 057714
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License Number State | NY
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