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NPI Code Detail

MEDICARE: DR. SHANE GREGORY KROHNFELDT DDS

MEDICARE: DR. SHANE GREGORY KROHNFELDT DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDD4823NM
21223G0001XGeneral Practice Dentistry103623CA
31223G0001XGeneral Practice DentistryDD4823NM

General Provider Information

NPI Number : 1164937421
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE GREGORY KROHNFELDT DDS
Provider Business Mailing Address
First Line : 6425 HOLLY AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-2474
Country : US
Telephone Number : 505-828-2020
Fax Number :
Provider Business Practice Location Address
First Line : 6425 HOLLY AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-2474
Country : US
Telephone Number : 505-828-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2017
Last Update Date : 11/02/2022

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