Provider Demographics
NPI:1023001641
Name:DR BERNARD KRUPP, DDS, OMS, PA
Entity Type:Organization
Organization Name:DR BERNARD KRUPP, DDS, OMS, PA
Other - Org Name:LEONARD SPECTOR, DDS AND BERNARD IAN KRUPP, DDS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OMS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:KRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-583-7600
Mailing Address - Street 1:1220B E JOPPA RD
Mailing Address - Street 2:STE 314
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5813
Mailing Address - Country:US
Mailing Address - Phone:410-583-7600
Mailing Address - Fax:410-583-9669
Practice Address - Street 1:1220B E JOPPA RD
Practice Address - Street 2:STE 314
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5813
Practice Address - Country:US
Practice Address - Phone:410-583-7600
Practice Address - Fax:410-583-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD029693700Medicaid
MD125LMedicare ID - Type Unspecified