Provider Demographics
NPI:1568422103
Name:KRAUSE, CANDACE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:LEE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2156
Mailing Address - Country:US
Mailing Address - Phone:503-657-3077
Mailing Address - Fax:503-655-5729
Practice Address - Street 1:1105 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2156
Practice Address - Country:US
Practice Address - Phone:503-657-3077
Practice Address - Fax:503-655-5729
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD60821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice