1841209053 NPI number — JOHN L KRUMPOTICH DDS FAGD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841209053 NPI number — JOHN L KRUMPOTICH DDS FAGD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN L KRUMPOTICH DDS FAGD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMBER MEADOWS FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841209053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 THOMAS JOHNSON DRIVE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-663-5552
Provider Business Mailing Address Fax Number:
301-663-4629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 THOMAS JOHNSON DRIVE
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
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:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRUMPOTICH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
DENTIST PRESIDENT
Authorized Official Telephone Number:
301-663-5552

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , 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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