Provider Demographics
NPI:1720044126
Name:KRUEGER, KEITH EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EDWARD
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1475 SW CHANDLER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3238
Mailing Address - Country:US
Mailing Address - Phone:541-617-3993
Mailing Address - Fax:541-617-0030
Practice Address - Street 1:1475 SW CHANDLER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3238
Practice Address - Country:US
Practice Address - Phone:541-617-3993
Practice Address - Fax:541-617-0030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD66291223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology