Provider Demographics
NPI:1780023325
Name:KREKELBERG, JOSEPH LEO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEO
Last Name:KREKELBERG
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 1:1675 MONTCLAIR RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2407
Mailing Address - Country:US
Mailing Address - Phone:205-957-0106
Mailing Address - Fax:
Practice Address - Street 1:1675 MONTCLAIR RD
Practice Address - Street 2:SUITE 212
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2407
Practice Address - Country:US
Practice Address - Phone:205-957-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist