Provider Demographics
NPI:1821173204
Name:KRALIK, SHAWN (DDS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:KRALIK
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 1:910 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1002
Mailing Address - Country:US
Mailing Address - Phone:402-372-2418
Mailing Address - Fax:402-372-5060
Practice Address - Street 1:910 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1002
Practice Address - Country:US
Practice Address - Phone:402-372-2418
Practice Address - Fax:402-372-5060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025157600Medicaid