Provider Demographics
NPI:1477797850
Name:KRUTOY, JEFFREY B (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:KRUTOY
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CASTANO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3747
Mailing Address - Country:US
Mailing Address - Phone:678-313-0884
Mailing Address - Fax:
Practice Address - Street 1:1405 WESTGATE CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2995
Practice Address - Country:US
Practice Address - Phone:367-655-3743
Practice Address - Fax:336-760-3066
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311831223S0112X
NC111321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery