Provider Demographics
NPI:1689797821
Name:JERRY W. KRAPE , DDS
Entity Type:Organization
Organization Name:JERRY W. KRAPE , DDS
Other - Org Name:JERRY W. KRAPE, DDS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-842-4858
Mailing Address - Street 1:700 FEDERAL HIGHWAY US#1
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403
Mailing Address - Country:US
Mailing Address - Phone:561-842-4858
Mailing Address - Fax:
Practice Address - Street 1:700 FEDERAL HIGHWAY US#1
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403
Practice Address - Country:US
Practice Address - Phone:561-842-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL855415OtherBCBS