Provider Demographics
NPI:1770848608
Name:KROFFKE, BRANDON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES
Last Name:KROFFKE
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 1:15207 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-5020
Mailing Address - Country:US
Mailing Address - Phone:440-572-4840
Mailing Address - Fax:440-572-3814
Practice Address - Street 1:15207 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5020
Practice Address - Country:US
Practice Address - Phone:440-572-4840
Practice Address - Fax:440-572-3814
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0237441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice