MEDICARE: MR. PHILIP D KRAMER JR. 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	122300000X	Dentist	1848	LA

General Provider Information

NPI Number	:	1639281660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP D KRAMER JR. DDS

Provider Business Mailing Address
First Line	:	P. O. BOX 767
Second Line	:
City	:	WELSH
State	:	LA
Zip	:	70591
Country	:	US
Telephone Number	:	337-734-3418
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 OAK PARK BLVD.
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-8845
Country	:	US
Telephone Number	:	337-478-2960
Fax Number	:	337-478-2964

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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