Provider Demographics
NPI:1255323366
Name:KRAUSE, PAUL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:KRAUSE
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 1:721 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2003
Mailing Address - Country:US
Mailing Address - Phone:402-558-6867
Mailing Address - Fax:
Practice Address - Street 1:258 N 114TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2515
Practice Address - Country:US
Practice Address - Phone:402-334-9239
Practice Address - Fax:402-334-4184
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064498500Medicaid