Provider Demographics
NPI:1003894577
Name:KRIEG, WILLIAM L (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:KRIEG
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22006 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2307
Mailing Address - Country:US
Mailing Address - Phone:586-772-6090
Mailing Address - Fax:586-772-0621
Practice Address - Street 1:22006 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2307
Practice Address - Country:US
Practice Address - Phone:586-772-6090
Practice Address - Fax:586-772-0621
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0128791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics