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General NPI Number Information
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NPI Number | 1992963573
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Entity Type | Organization
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Legal Business Name | J. MICHAEL KROE,D.D.S.,PA
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 280 E MAIN ST SUITE 100
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City | WESTMINSTER
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State | MD
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Zip | 21157-5525
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Country | US
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Telephone | 410-848-9595
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Fax | 410-848-9596
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Provider Business Mailing Address
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Address Line | 280 E MAIN ST SUITE 100
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City | WESTMINSTER
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State | MD
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Zip | 21157-5525
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Country | US
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Telephone | 410-848-9595
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Fax | 410-848-9596
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Authorized Official
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Title or Position | DIRECTOR OF THE BOARD
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Name | DR. JOHNNY MICHAEL KROE
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Credential | D.D.S.
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Telephone | 410-848-9595
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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 | 5003
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License Number State | MD
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