MEDICARE: DR. AMY KATHERINE KRAUSE DMD

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	1223G0001X	General Practice Dentistry	20511	OH

General Provider Information

NPI Number	:	1295965184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY KATHERINE KRAUSE DMD

Provider Business Mailing Address
First Line	:	8401 HOWLAND SPRINGS RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-3120
Country	:	US
Telephone Number	:	330-856-2177
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 HOWLAND SPRINGS RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-3120
Country	:	US
Telephone Number	:	330-856-2177
Fax Number	:

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

Provider Enumeration Date	:	07/26/2009
Last Update Date	:	07/26/2009

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