Provider Demographics
NPI:1194038125
Name:KROKEE, ANNA (RDHAP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KROKEE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1833
Mailing Address - Country:US
Mailing Address - Phone:858-220-9087
Mailing Address - Fax:858-488-4250
Practice Address - Street 1:1253 OPAL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1833
Practice Address - Country:US
Practice Address - Phone:858-220-9087
Practice Address - Fax:858-488-4250
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300124Q00000X
CO22521124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist