Provider Demographics
NPI:1912254160
Name:KRAMER, MITCHELL W (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:W
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:140 TWIN RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2015
Mailing Address - Country:US
Mailing Address - Phone:320-257-3380
Mailing Address - Fax:320-257-3381
Practice Address - Street 1:140 TWIN RIVERS CT
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2015
Practice Address - Country:US
Practice Address - Phone:320-257-3380
Practice Address - Fax:320-257-3381
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE7009122300000X
MND133411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist