Provider Demographics
NPI:1801816020
Name:KRATZENBERG, THOMAS D (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:KRATZENBERG
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 1:1532 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15131-1712
Mailing Address - Country:US
Mailing Address - Phone:412-672-1199
Mailing Address - Fax:
Practice Address - Street 1:1532 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-1712
Practice Address - Country:US
Practice Address - Phone:412-672-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027815-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS027815-LOtherSTATE LICENSE