Provider Demographics
NPI:1790197390
Name:KREITZER, MICHAEL KARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KARL
Last Name:KREITZER
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 1:5152 BLAZER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7323
Mailing Address - Country:US
Mailing Address - Phone:614-333-8297
Mailing Address - Fax:
Practice Address - Street 1:5152 BLAZER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7323
Practice Address - Country:US
Practice Address - Phone:614-333-8297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18565311223P0300X
OH30.0251781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics