Provider Demographics
NPI:1740767748
Name:KRUPP, DYLAN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:KRUPP
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 1:25 CLEVELAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2935
Mailing Address - Country:US
Mailing Address - Phone:276-632-6219
Mailing Address - Fax:276-632-8356
Practice Address - Street 1:25 CLEVELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2935
Practice Address - Country:US
Practice Address - Phone:276-632-6219
Practice Address - Fax:276-632-8356
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice