Provider Demographics
NPI:1588952733
Name:KROLL, MICHAEL A (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:KROLL
Suffix:
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 1:4431 68TH ST.
Mailing Address - Street 2:ATTN: DENTAC CREDENTIALS
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-287-2705
Mailing Address - Fax:254-287-1786
Practice Address - Street 1:4431 68TH ST.
Practice Address - Street 2:ATTN: DENTAC CREDENTIALS
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-2705
Practice Address - Fax:254-287-1786
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist