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General NPI Number Information
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NPI Number | 1487735064
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Entity Type | Individual
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Provider Name | THOMAS KRAKOWER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/31/2018
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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 | 1088 W BALTIMORE PIKE STE 2304
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City | MEDIA
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State | PA
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Zip | 19063-5136
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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 |
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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 | 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 | PR
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