Provider Demographics
NPI:1477783132
Name:KROMMENHOEK, DALLAS JAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:JAN
Last Name:KROMMENHOEK
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 1:4105 WESTBANK DR
Mailing Address - Street 2:#103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4455
Mailing Address - Country:US
Mailing Address - Phone:512-327-6908
Mailing Address - Fax:512-327-6695
Practice Address - Street 1:4105 WESTBANK DR
Practice Address - Street 2:#103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4455
Practice Address - Country:US
Practice Address - Phone:512-327-6908
Practice Address - Fax:512-327-6695
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist