Provider Demographics
NPI:1114321122
Name:JOHN A KRASOWSKI DDS LLC
Entity Type:Organization
Organization Name:JOHN A KRASOWSKI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRASOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-845-9372
Mailing Address - Street 1:550 N 17TH AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2901
Mailing Address - Country:US
Mailing Address - Phone:715-845-9372
Mailing Address - Fax:715-845-7849
Practice Address - Street 1:550 N 17TH AVE
Practice Address - Street 2:STE 2
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2901
Practice Address - Country:US
Practice Address - Phone:715-845-9372
Practice Address - Fax:715-845-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4434WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty