Provider Demographics
NPI:1093091688
Name:DANIEL J KRESS DDS, INC
Entity Type:Organization
Organization Name:DANIEL J KRESS DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-689-5151
Mailing Address - Street 1:823 S ADAMS, HWY421S
Mailing Address - Street 2:PO BOX 685
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042
Mailing Address - Country:US
Mailing Address - Phone:812-689-5151
Mailing Address - Fax:812-689-6303
Practice Address - Street 1:823 S ADAMS, HWY421S
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042
Practice Address - Country:US
Practice Address - Phone:812-689-5151
Practice Address - Fax:812-689-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000520A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201144140Medicaid