MEDICARE: DR. PETER A KRAKOWIAK 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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	49350	CA

General Provider Information

NPI Number	:	1659461721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A KRAKOWIAK DMD

Provider Business Mailing Address
First Line	:	265 SAN JACINTO RIVER RD
Second Line	:	STE. 101
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4400
Country	:	US
Telephone Number	:	951-471-3334
Fax Number	:	951-471-3347

Provider Business Practice Location Address
First Line	:	265 SAN JACINTO RIVER RD
Second Line	:	STE. 101
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4400
Country	:	US
Telephone Number	:	951-471-3334
Fax Number	:	951-471-3347

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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