MEDICARE: KRUPA DENTAL CARE, P.C.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1538494703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRUPA DENTAL CARE, P.C.

Provider Business Mailing Address
First Line	:	8240 WOLF RD
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8240 WOLF RD
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1084
Country	:	US
Telephone Number	:	708-839-5529
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS E KRUPA
Credential	:	D.D.S.
Telephone Number	:	708-839-5529

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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