Provider Demographics
NPI:1265500136
Name:KRUPKA, JOHN NORBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NORBERT
Last Name:KRUPKA
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:N3214 FEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9698
Mailing Address - Country:US
Mailing Address - Phone:920-766-1122
Mailing Address - Fax:
Practice Address - Street 1:1901 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3200
Practice Address - Country:US
Practice Address - Phone:920-766-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist