Provider Demographics
NPI:1386985281
Name:KRAUSE, EVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 GETTYSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1837
Mailing Address - Country:US
Mailing Address - Phone:201-953-9889
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD
Practice Address - Street 2:SUITE J-2
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9441
Practice Address - Country:US
Practice Address - Phone:973-334-5556
Practice Address - Fax:973-331-0134
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02547000122300000X
NY057714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist