Provider Demographics
NPI:1689012320
Name:KREAGER, NATHANAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:JOSEPH
Last Name:KREAGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 ROBERT ST S # 100
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3942
Mailing Address - Country:US
Mailing Address - Phone:651-505-3242
Mailing Address - Fax:
Practice Address - Street 1:1963 ROBERT ST S # 100
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3942
Practice Address - Country:US
Practice Address - Phone:651-505-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13221122300000X
WI7154-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist