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General NPI Number Information
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NPI Number | 1790768562
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Entity Type | Individual
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Provider Name | JACK ISSAC KRAJEKIAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1215 VIRGINIA ST E
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City | CHARLESTON
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State | WV
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Zip | 25301-2908
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Country | US
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Telephone | 304-345-1092
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Fax | 304-345-1095
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Provider Business Mailing Address
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Address Line | 1215 VIRGINIA ST E
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City | CHARLESTON
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State | WV
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Zip | 25301-2908
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Country | US
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Telephone | 304-345-1092
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Fax | 304-345-1095
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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 | 3542
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 116
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS036241
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19714
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License Number State | MA
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