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General NPI Number Information
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NPI Number | 1417185893
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Entity Type | Organization
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Legal Business Name | THOMAS KRAKOWER, D.M.D., LLC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 1068 W BALTIMORE PIKE SUITE 2304 RIDDLE HEALTH CARE CENTER II
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City | MEDIA
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State | PA
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Zip | 19063-5104
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Country | US
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Telephone | 610-744-2888
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Fax | 610-744-2832
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Provider Business Mailing Address
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Address Line | 1068 W BALTIMORE PIKE SUITE 2304 RIDDLE HEALTH CARE CENTER II
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City | MEDIA
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State | PA
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Zip | 19063-5104
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Country | US
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Telephone | 610-744-2888
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Fax | 610-744-2832
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | THOMAS KRAKOWER
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Credential | D.M.D.
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Telephone | 610-744-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS018722L
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License Number State | PA
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