Provider Demographics
NPI:1053334680
Name:KRUGER, ALAN WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:WAYNE
Last Name:KRUGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2811
Mailing Address - Country:US
Mailing Address - Phone:319-283-4222
Mailing Address - Fax:319-283-5686
Practice Address - Street 1:135 7TH ST SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2811
Practice Address - Country:US
Practice Address - Phone:319-283-4222
Practice Address - Fax:319-283-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA064911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159707Medicaid
IA15970OtherWELLMARK