Provider Demographics
NPI:1811978786
Name:KRANTZ, RICHARD LYNN (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LYNN
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 1:2086 OLD HWY 135
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112
Mailing Address - Country:US
Mailing Address - Phone:812-734-1388
Mailing Address - Fax:
Practice Address - Street 1:4309 COUNTRY VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119
Practice Address - Country:US
Practice Address - Phone:812-923-6581
Practice Address - Fax:812-923-6581
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3767122300000X
IN12008957B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60037678Medicaid