Provider Demographics
NPI:1427456110
Name:KRAWIEC, CHRIS JOHN SR (DMD)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:JOHN
Last Name:KRAWIEC
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1107
Mailing Address - Country:US
Mailing Address - Phone:502-634-1208
Mailing Address - Fax:
Practice Address - Street 1:3117 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1107
Practice Address - Country:US
Practice Address - Phone:502-634-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice