MEDICARE: DR. MARY SUSAN KROTZINGER D.D.S.

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	014312	MO
2	1223D0001X	Public Health Dentistry	HAD 56	FL

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

General Provider Information

NPI Number	:	1992796973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SUSAN KROTZINGER D.D.S.

Provider Business Mailing Address
First Line	:	5001 SW 20TH ST APT 3014
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34474-8567
Country	:	US
Telephone Number	:	352-671-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 SW 20TH ST APT 3014
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34474-8567
Country	:	US
Telephone Number	:	352-671-9771
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	10/28/2015

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