Provider Demographics
NPI:1689745192
Name:KRASNE, BRADLEY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:G
Last Name:KRASNE
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 1:500 MAIN PLACE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2211
Mailing Address - Country:US
Mailing Address - Phone:316-283-8261
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN PLACE
Practice Address - Street 2:SUITE 214
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2211
Practice Address - Country:US
Practice Address - Phone:316-283-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice