Provider Demographics
NPI:1134668924
Name:KROFFKE DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KROFFKE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KROFFKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-591-1821
Mailing Address - Street 1:3487 CENTER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3624
Mailing Address - Country:US
Mailing Address - Phone:330-273-1600
Mailing Address - Fax:330-225-7687
Practice Address - Street 1:3487 CENTER RD STE 8
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3624
Practice Address - Country:US
Practice Address - Phone:330-273-1600
Practice Address - Fax:330-225-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty