Provider Demographics
NPI:1104680479
Name:DRACHENBERG, KRAUSS (DDS)
Entity type:Individual
Prefix:
First Name:KRAUSS
Middle Name:
Last Name:DRACHENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 EASTLAKE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4521
Mailing Address - Country:US
Mailing Address - Phone:619-934-3258
Mailing Address - Fax:
Practice Address - Street 1:890 EASTLAKE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4521
Practice Address - Country:US
Practice Address - Phone:619-934-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice