Provider Demographics
NPI:1710090584
Name:KROOPNICK, RALPH LEONARD (DMD)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LEONARD
Last Name:KROOPNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 MIDDLE TPKE., RT. 44
Mailing Address - Street 2:MANSFIELD SHOPPING PLAZA
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1667
Mailing Address - Country:US
Mailing Address - Phone:860-429-0079
Mailing Address - Fax:860-429-3190
Practice Address - Street 1:591 MIDDLE TPKE., RT. 44
Practice Address - Street 2:MANSFIELD SHOPPING PLAZA
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1667
Practice Address - Country:US
Practice Address - Phone:860-429-0079
Practice Address - Fax:860-429-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3498122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002034981Medicaid