Provider Demographics
NPI:1770583551
Name:KROCHMAL, JAMES ELLIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELLIS
Last Name:KROCHMAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 W BRAMBLETON AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1115
Mailing Address - Country:US
Mailing Address - Phone:757-440-7777
Mailing Address - Fax:757-550-2182
Practice Address - Street 1:400 W BRAMBLETON AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-440-7777
Practice Address - Fax:757-550-2182
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010067031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190000201Medicare PIN
VAT21399Medicare UPIN