Provider Demographics
NPI:1386656247
Name:KRAUSE, JON M (DDS;PC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:DDS;PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3760
Mailing Address - Country:US
Mailing Address - Phone:417-588-2562
Mailing Address - Fax:417-588-2267
Practice Address - Street 1:1739 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3760
Practice Address - Country:US
Practice Address - Phone:417-588-2562
Practice Address - Fax:417-588-2267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO153231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice