Provider Demographics
NPI:1821199852
Name:MICHAEL T KRATZ DDS PA
Entity type:Organization
Organization Name:MICHAEL T KRATZ DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-922-2214
Mailing Address - Street 1:3939 W 50TH STREET
Mailing Address - Street 2:#208
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:952-922-2214
Mailing Address - Fax:952-922-3903
Practice Address - Street 1:3939 W 50TH STREET
Practice Address - Street 2:#208
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424
Practice Address - Country:US
Practice Address - Phone:952-922-2214
Practice Address - Fax:952-922-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109561223G0001X
MN60031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN75640B200Medicare ID - Type UnspecifiedDR KRATZ