Provider Demographics
NPI:1750424263
Name:BRASSEALE, KRIEGER WEBB (DDS)
Entity type:Individual
Prefix:DR
First Name:KRIEGER
Middle Name:WEBB
Last Name:BRASSEALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7321 EAGLE CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8157
Mailing Address - Country:US
Mailing Address - Phone:812-402-9600
Mailing Address - Fax:812-402-9605
Practice Address - Street 1:7321 EAGLE CREST BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8157
Practice Address - Country:US
Practice Address - Phone:812-402-9600
Practice Address - Fax:812-402-9605
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010141A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics