Provider Demographics
NPI:1497828172
Name:DONNA G. KRAKLOW D.D.S.
Entity Type:Organization
Organization Name:DONNA G. KRAKLOW D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:KRAKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-547-4433
Mailing Address - Street 1:1507 E SUNSET DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189
Mailing Address - Country:US
Mailing Address - Phone:262-547-4433
Mailing Address - Fax:262-547-2977
Practice Address - Street 1:1507 E SUNSET DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189
Practice Address - Country:US
Practice Address - Phone:262-547-4433
Practice Address - Fax:262-547-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty