Provider Demographics
NPI:1932497385
Name:KRAUSE, KELSEY MILES (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MILES
Last Name:KRAUSE
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 1:19723 E ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8664
Mailing Address - Country:US
Mailing Address - Phone:480-390-6691
Mailing Address - Fax:
Practice Address - Street 1:1855 S COUNTRY CLUB DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6037
Practice Address - Country:US
Practice Address - Phone:480-612-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice