Provider Demographics
NPI:1245396373
Name:KRAUSE DENTAL EXCELLENCE PC
Entity Type:Organization
Organization Name:KRAUSE DENTAL EXCELLENCE PC
Other - Org Name:KRAUSE DENTAL EXCELLENCE, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-725-9321
Mailing Address - Street 1:51160 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2159
Mailing Address - Country:US
Mailing Address - Phone:586-725-9321
Mailing Address - Fax:586-725-5108
Practice Address - Street 1:51160 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2159
Practice Address - Country:US
Practice Address - Phone:586-725-9321
Practice Address - Fax:586-725-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014272261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental