Provider Demographics
NPI:1982851440
Name:KRUEGER, GERARD E (DDS,MS,FACP)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:E
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:DDS,MS,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1107
Mailing Address - Country:US
Mailing Address - Phone:727-345-2064
Mailing Address - Fax:727-345-1645
Practice Address - Street 1:7801 38TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1107
Practice Address - Country:US
Practice Address - Phone:727-345-2064
Practice Address - Fax:727-345-1645
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67835OtherBLUECROSSBLUESHEILD