Provider Demographics
NPI:1740841907
Name:KRATZ, MARY M (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:KRATZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:PEARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13001 N OUTER 40 RD STE 360
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5941
Mailing Address - Country:US
Mailing Address - Phone:314-626-4579
Mailing Address - Fax:
Practice Address - Street 1:13001 N OUTER 40 RD STE 360
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-626-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190213431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019021343OtherMISSOURI PROFESSIONAL LICENSE