Provider Demographics
NPI:1538261664
Name:CRONK, RAYMOND JAY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JAY
Last Name:CRONK
Suffix:JR
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 1:115 S 10TH
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361
Mailing Address - Country:US
Mailing Address - Phone:402-759-3097
Mailing Address - Fax:
Practice Address - Street 1:115 S 10TH
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361
Practice Address - Country:US
Practice Address - Phone:402-759-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist