Provider Demographics
NPI:1881715308
Name:KRAFT, MOIRA KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:KATHLEEN
Last Name:KRAFT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 TALLADEGA CT
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8075
Mailing Address - Country:US
Mailing Address - Phone:920-983-0190
Mailing Address - Fax:
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2609
Practice Address - Country:US
Practice Address - Phone:920-336-2500
Practice Address - Fax:920-336-4684
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5869-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice