1083738082 NPI number — DR. JOHN LEWIS KRUMPOTICH JR. D.D.S.

Table of content: DR. JOHN LEWIS KRUMPOTICH JR. D.D.S. (NPI 1083738082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083738082 NPI number — DR. JOHN LEWIS KRUMPOTICH JR. D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUMPOTICH
Provider First Name:
JOHN
Provider Middle Name:
LEWIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRUMPOTICH
Provider Other First Name:
JOHN
Provider Other Middle Name:
LEWIS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1083738082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6807 CHERRY TREE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW MARKET
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21774-6702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-829-3356
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-663-5552
Provider Business Practice Location Address Fax Number:
301-663-4629
Provider Enumeration Date:
03/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8036 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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