Provider Demographics
NPI:1386873115
Name:KRATZER, KRISTIN L (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:KRATZER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:KRATZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1424 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-4025
Mailing Address - Country:US
Mailing Address - Phone:610-867-4461
Mailing Address - Fax:610-867-9354
Practice Address - Street 1:1424 BROADWAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-4025
Practice Address - Country:US
Practice Address - Phone:610-867-4461
Practice Address - Fax:610-867-9354
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60941223G0001X
PADS0385111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice