Provider Demographics
NPI:1720164627
Name:KRUPA, GARY MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARTIN
Last Name:KRUPA
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 1:2628 EL CAMINO AVE
Mailing Address - Street 2:C10
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5925
Mailing Address - Country:US
Mailing Address - Phone:916-481-4242
Mailing Address - Fax:916-481-9702
Practice Address - Street 1:2628 EL CAMINO
Practice Address - Street 2:C10
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5925
Practice Address - Country:US
Practice Address - Phone:916-481-4242
Practice Address - Fax:916-481-9702
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29333122300000X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist