Provider Demographics
NPI:1942323787
Name:KRENZ, JON C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:KRENZ
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:P.O. BOX 167
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342
Mailing Address - Country:US
Mailing Address - Phone:815-538-5316
Mailing Address - Fax:815-539-7626
Practice Address - Street 1:704 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1617
Practice Address - Country:US
Practice Address - Phone:815-538-5316
Practice Address - Fax:815-539-7626
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice