Provider Demographics
NPI:1851488555
Name:KROMHOUT, ANA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:E
Last Name:KROMHOUT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 RIDGEWOOD XING
Mailing Address - Street 2:SUITE K
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3531
Mailing Address - Country:US
Mailing Address - Phone:330-733-7911
Mailing Address - Fax:330-376-5214
Practice Address - Street 1:620 RIDGEWOOD XING
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3531
Practice Address - Country:US
Practice Address - Phone:330-733-7911
Practice Address - Fax:330-376-5214
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0995679Medicaid