MEDICARE: GREGG R. KROEN DDS PA

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	DN6866	FL

General Provider Information

NPI Number	:	1487862553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGG R. KROEN DDS PA

Provider Business Mailing Address
First Line	:	1299 HOWELL BRANCH RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-1005
Country	:	US
Telephone Number	:	407-647-7775
Fax Number	:	407-629-6499

Provider Business Practice Location Address
First Line	:	1299 HOWELL BRANCH RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-1005
Country	:	US
Telephone Number	:	407-647-7775
Fax Number	:	407-629-6499

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGG RENO KROEN
Credential	:
Telephone Number	:	407-647-7775

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	08/22/2020

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