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General NPI Number Information
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NPI Number | 1598783664
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Entity Type | Individual
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Provider Name | GARY DOUGLAS KRUEGER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 320 SANTA FE DR SUITE #201
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City | ENCINITAS
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State | CA
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Zip | 92024-5138
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Country | US
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Telephone | 760-479-0961
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Fax | 760-479-0963
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Provider Business Mailing Address
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Address Line | 320 SANTA FE DR SUITE #201
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City | ENCINITAS
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State | CA
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Zip | 92024-5138
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Country | US
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Telephone | 760-479-0961
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Fax | 760-479-0963
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 42347
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License Number State | CA
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