Provider Demographics
NPI:1841209053
Name:JOHN L KRUMPOTICH DDS FAGD PA
Entity type:Organization
Organization Name:JOHN L KRUMPOTICH DDS FAGD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KRUMPOTICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-663-5552
Mailing Address - Street 1:196 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-663-5552
Mailing Address - Fax:301-663-4629
Practice Address - Street 1:196 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-663-5552
Practice Address - Fax:301-663-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty