Provider Demographics
NPI:1497941280
Name:KRUTZFELDT, DANAE LYNNE (DDS)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:LYNNE
Last Name:KRUTZFELDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANAE
Other - Middle Name:LYNNE
Other - Last Name:WINGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3475 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:563-359-5510
Mailing Address - Fax:563-359-3051
Practice Address - Street 1:412 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2947
Practice Address - Country:US
Practice Address - Phone:641-844-6230
Practice Address - Fax:641-844-6235
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0268888Medicaid
IA161815Medicare PIN