Provider Demographics
NPI:1386776177
Name:KRAKOW, A. MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:MICHAEL
Last Name:KRAKOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KRAKOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:150 BERGEN ST
Mailing Address - Street 2:UNIT ONE (1)
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:973-972-5026
Mailing Address - Fax:973-972-1986
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UNIT ONE (1)
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-5026
Practice Address - Fax:973-972-1986
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist