Provider Demographics
NPI:1659757581
Name:KRUPA, GRZEGORZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRZEGORZ
Middle Name:
Last Name:KRUPA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 BRIARTREE LN
Mailing Address - Street 2:UNIT 403
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-3006
Mailing Address - Country:US
Mailing Address - Phone:708-310-2202
Mailing Address - Fax:
Practice Address - Street 1:7536 BRIARTREE LN
Practice Address - Street 2:UNIT 403
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-3006
Practice Address - Country:US
Practice Address - Phone:708-310-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist