Provider Demographics
NPI:1780710301
Name:KRAUSS, TIMOTHY OWEN (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:OWEN
Last Name:KRAUSS
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 1:8307 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1808
Mailing Address - Country:US
Mailing Address - Phone:317-271-3700
Mailing Address - Fax:317-273-0035
Practice Address - Street 1:8307 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1808
Practice Address - Country:US
Practice Address - Phone:317-271-3700
Practice Address - Fax:317-273-0035
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice