MEDICARE: DR. JOSEPH JOHN KRUPA III 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6496	NC
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9256	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427121078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JOHN KRUPA III DDS

Provider Business Mailing Address
First Line	:	PO BOX 743904
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3904
Country	:	US
Telephone Number	:	803-296-7320
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	3304 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4024
Country	:	US
Telephone Number	:	803-551-2572
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	05/05/2020

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