Provider Demographics
NPI:1356457683
Name:KRATZ, MICHAEL THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:KRATZ
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 1:3939 W 50TH ST
Mailing Address - Street 2:#208
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:952-922-2214
Mailing Address - Fax:952-922-3903
Practice Address - Street 1:3939 W 50TH ST
Practice Address - Street 2:#208
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424
Practice Address - Country:US
Practice Address - Phone:952-922-2214
Practice Address - Fax:952-922-3903
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice