Provider Demographics
NPI:1699032490
Name:DAVID J. KRYNAUW, DDS, PA
Entity Type:Organization
Organization Name:DAVID J. KRYNAUW, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRYNAUW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-335-0993
Mailing Address - Street 1:1761 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5479
Mailing Address - Country:US
Mailing Address - Phone:772-335-0993
Mailing Address - Fax:772-335-8192
Practice Address - Street 1:1761 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5479
Practice Address - Country:US
Practice Address - Phone:772-335-0993
Practice Address - Fax:772-335-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13287261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental