Provider Demographics
NPI:1194447789
Name:KROCHMAL DENTAL INC
Entity type:Organization
Organization Name:KROCHMAL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROCHMAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-636-0378
Mailing Address - Street 1:893 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2411
Mailing Address - Country:US
Mailing Address - Phone:617-323-3443
Mailing Address - Fax:
Practice Address - Street 1:893 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2411
Practice Address - Country:US
Practice Address - Phone:617-323-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental