Provider Demographics
NPI:1649377862
Name:KRASOWSKI, JOHN ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADAM
Last Name:KRASOWSKI
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 1:550 N 17TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-845-9372
Mailing Address - Fax:715-845-7849
Practice Address - Street 1:550 N 17TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-845-9372
Practice Address - Fax:715-845-7849
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4434WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist