MEDICARE: EDWARD KRUKOWSKI

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
1	122300000X	Dentist	DN11476	FL

General Provider Information

NPI Number	:	1275747305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD KRUKOWSKI

Provider Business Mailing Address
First Line	:	9801 COLLINS AVE
Second Line	:	SUITEC-102
City	:	BAL HARBOUR
State	:	FL
Zip	:	33154-1815
Country	:	US
Telephone Number	:	305-866-6662
Fax Number	:	305-866-6662

Provider Business Practice Location Address
First Line	:	9801 COLLINS AVE
Second Line	:	SUITEC-102
City	:	BAL HARBOUR
State	:	FL
Zip	:	33154-1815
Country	:	US
Telephone Number	:	305-866-6662
Fax Number	:	305-866-6662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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Directions to “ EDWARD KRUKOWSKI ” Practice Location

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