Provider Demographics
NPI:1700018579
Name:KRAUSE, KODY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KODY
Middle Name:JOHN
Last Name:KRAUSE
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 1:1105 4TH AVE E STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4018
Mailing Address - Country:US
Mailing Address - Phone:360-754-5363
Mailing Address - Fax:360-705-2718
Practice Address - Street 1:1105 4TH AVE E STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4018
Practice Address - Country:US
Practice Address - Phone:360-754-5363
Practice Address - Fax:360-705-2718
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60938388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist