Provider Demographics
NPI:1407015605
Name:KRAWIEC, JUSTIN HERBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:HERBERT
Last Name:KRAWIEC
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 1:18400 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2317
Mailing Address - Country:US
Mailing Address - Phone:313-836-1111
Mailing Address - Fax:313-836-1371
Practice Address - Street 1:18400 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2317
Practice Address - Country:US
Practice Address - Phone:313-836-1111
Practice Address - Fax:313-836-1371
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901019782OtherSTATE LICENSE NUMBER