Provider Demographics
NPI:1245217843
Name:KREUTNER, MARK HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:KREUTNER
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 1:1351 N LENNOX CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2429
Mailing Address - Country:US
Mailing Address - Phone:417-864-8031
Mailing Address - Fax:
Practice Address - Street 1:1724 NEBRASKA AVE
Practice Address - Street 2:USA DENTAC, BLDG 1608
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8939
Practice Address - Country:US
Practice Address - Phone:573-596-0369
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0123701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice