Provider Demographics
NPI:1780730580
Name:KREIDER & KROGG DDS INC
Entity type:Organization
Organization Name:KREIDER & KROGG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:KROGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-390-3050
Mailing Address - Street 1:2220 GRUBE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2643
Mailing Address - Country:US
Mailing Address - Phone:937-390-3050
Mailing Address - Fax:937-390-9840
Practice Address - Street 1:2220 GRUBE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2643
Practice Address - Country:US
Practice Address - Phone:937-390-3050
Practice Address - Fax:937-390-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2164643Medicaid