Provider Demographics
NPI:1275673006
Name:KRUGER, MARTIN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PAUL
Last Name:KRUGER
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 1:6 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3140
Mailing Address - Country:US
Mailing Address - Phone:949-240-6998
Mailing Address - Fax:
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 450
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3626
Practice Address - Country:US
Practice Address - Phone:949-830-0074
Practice Address - Fax:949-454-9419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice