Provider Demographics
NPI:1104039502
Name:KRAVER, INC.
Entity Type:Organization
Organization Name:KRAVER, INC.
Other - Org Name:CAPE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:KRAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-542-6661
Mailing Address - Street 1:3001 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7208
Mailing Address - Country:US
Mailing Address - Phone:239-542-6661
Mailing Address - Fax:239-542-2811
Practice Address - Street 1:3001 DEL PRADO BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7208
Practice Address - Country:US
Practice Address - Phone:239-542-6661
Practice Address - Fax:239-542-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN114081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty