Provider Demographics
NPI:1114191418
Name:KOLE KRASNIQI DDS, PC
Entity Type:Organization
Organization Name:KOLE KRASNIQI DDS, PC
Other - Org Name:EAST RIDGE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASNIQI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-786-1132
Mailing Address - Street 1:3918 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3648
Mailing Address - Country:US
Mailing Address - Phone:816-786-1132
Mailing Address - Fax:816-817-0504
Practice Address - Street 1:3918 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3648
Practice Address - Country:US
Practice Address - Phone:816-786-1132
Practice Address - Fax:816-817-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty