Provider Demographics
NPI:1063639110
Name:KRON, ROBERT O (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:O
Last Name:KRON
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 1:3535 W 12TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2557
Mailing Address - Country:US
Mailing Address - Phone:970-351-6095
Mailing Address - Fax:970-351-0155
Practice Address - Street 1:3535 W 12TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2557
Practice Address - Country:US
Practice Address - Phone:970-351-6095
Practice Address - Fax:970-351-0155
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1008931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02008936Medicaid
CO100893OtherDENTAL
CO985184OtherDENTAL
CO84465OtherDENTAL