Provider Demographics
NPI:1093737074
Name:KRASNE, JAY DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DAVID
Last Name:KRASNE
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 1:12208 SNEAD PLACE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624
Mailing Address - Country:US
Mailing Address - Phone:813-963-1873
Mailing Address - Fax:813-961-6169
Practice Address - Street 1:3331 W BEARSS AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2100
Practice Address - Country:US
Practice Address - Phone:813-968-5368
Practice Address - Fax:813-961-6169
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist