Provider Demographics
NPI:1528254331
Name:KRUPA, THOMAS ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ELLIOT
Last Name:KRUPA
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 1:8240 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1084
Mailing Address - Country:US
Mailing Address - Phone:708-839-5529
Mailing Address - Fax:708-839-4356
Practice Address - Street 1:8240 WOLF RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1084
Practice Address - Country:US
Practice Address - Phone:708-839-5529
Practice Address - Fax:708-839-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice