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General NPI Number Information
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NPI Number | 1689012320
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Entity Type | Individual
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Provider Name | NATHANAEL JOSEPH KREAGER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 1963 ROBERT ST S # 100
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-3942
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Country | US
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Telephone | 651-505-3242
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Fax |
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Provider Business Mailing Address
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Address Line | 1963 ROBERT ST S # 100
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-3942
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Country | US
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Telephone | 651-505-3242
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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 | D13221
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License Number State | MN
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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 | 7154-15
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License Number State | WI
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