Provider Demographics
NPI:1992729289
Name:KROE, JOHNNY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:MICHAEL
Last Name:KROE
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 1:280 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5525
Mailing Address - Country:US
Mailing Address - Phone:410-848-9595
Mailing Address - Fax:410-848-9596
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5525
Practice Address - Country:US
Practice Address - Phone:410-848-9595
Practice Address - Fax:410-848-9596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD50031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU43675Medicare ID - Type Unspecified