Provider Demographics
NPI:1952920035
Name:KRAMER, KEVIN (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 32ND ST LBBY LC
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6029
Mailing Address - Country:US
Mailing Address - Phone:316-516-7811
Mailing Address - Fax:
Practice Address - Street 1:153 E 32ND ST LBBY LC
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6029
Practice Address - Country:US
Practice Address - Phone:316-516-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY061835-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program