Provider Demographics
NPI:1215081765
Name:KRUEGER & ASSOCIATES LLC
Entity type:Organization
Organization Name:KRUEGER & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DMD
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-263-0850
Mailing Address - Street 1:213 S CLIFTON STREET
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:309-263-0850
Mailing Address - Fax:
Practice Address - Street 1:213 S CLIFTON STREET
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550
Practice Address - Country:US
Practice Address - Phone:309-263-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty