Provider Demographics
NPI:1780618058
Name:KRANTZ, ALAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:KRANTZ
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 1:11701 SAN JOSE BLVD.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-880-3131
Mailing Address - Fax:904-880-3169
Practice Address - Street 1:11701 SAN JOSE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0756
Practice Address - Country:US
Practice Address - Phone:904-880-3131
Practice Address - Fax:904-880-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice