Provider Demographics
NPI:1689845455
Name:CATSKILL ORAL SURGERY PC
Entity Type:Organization
Organization Name:CATSKILL ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-791-7360
Mailing Address - Street 1:457 BROADWAY STE 17
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1758
Mailing Address - Country:US
Mailing Address - Phone:845-791-7360
Mailing Address - Fax:845-791-7580
Practice Address - Street 1:457 BROADWAY
Practice Address - Street 2:STE 17
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1758
Practice Address - Country:US
Practice Address - Phone:845-791-7360
Practice Address - Fax:845-791-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty