Provider Demographics
NPI:1699798991
Name:KRUEGER, JOHN P (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KRUEGER
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 1:1651 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-6438
Mailing Address - Country:US
Mailing Address - Phone:727-441-3523
Mailing Address - Fax:
Practice Address - Street 1:1651 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-6438
Practice Address - Country:US
Practice Address - Phone:727-441-3523
Practice Address - Fax:727-443-7015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice