Provider Demographics
NPI:1982870655
Name:KREJCI, EDWIN JAMES JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JAMES
Last Name:KREJCI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2039 LYCOMING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1206
Mailing Address - Country:US
Mailing Address - Phone:570-323-2399
Mailing Address - Fax:570-323-2441
Practice Address - Street 1:2039 LYCOMING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1206
Practice Address - Country:US
Practice Address - Phone:570-323-2399
Practice Address - Fax:570-323-2441
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019650L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist