Provider Demographics
NPI:1033227376
Name:KRUPA, EDWARD C (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:KRUPA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:610-759-7224
Mailing Address - Fax:610-759-7424
Practice Address - Street 1:138 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-759-7224
Practice Address - Fax:610-759-7424
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027691L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice