Provider Demographics
NPI:1962665687
Name:KREUZE, MITCHELL P (DDS)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:P
Last Name:KREUZE
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 1:1060 GAFFNEY RD STOP 7500
Mailing Address - Street 2:
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5007
Mailing Address - Country:US
Mailing Address - Phone:907-353-5530
Mailing Address - Fax:
Practice Address - Street 1:1060 GAFFNEY RD STOP 7500
Practice Address - Street 2:
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5007
Practice Address - Country:US
Practice Address - Phone:907-353-5530
Practice Address - Fax:907-353-4859
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice