Provider Demographics
NPI:1720180011
Name:KRANTZ, JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:KRANTZ
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 1:645 E 11TH ST
Mailing Address - Street 2:APARTMENT 1-G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4134
Mailing Address - Country:US
Mailing Address - Phone:212-979-6300
Mailing Address - Fax:212-202-4173
Practice Address - Street 1:645 E 11TH ST
Practice Address - Street 2:APARTMENT 1-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4134
Practice Address - Country:US
Practice Address - Phone:212-979-6300
Practice Address - Fax:212-202-4173
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00693307Medicaid
NY13-4028528OtherTAX ID