Provider Demographics
NPI:1992796973
Name:KROTZINGER, MARY SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUSAN
Last Name:KROTZINGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 SW 20TH ST APT 3014
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8567
Mailing Address - Country:US
Mailing Address - Phone:352-671-9771
Mailing Address - Fax:
Practice Address - Street 1:5001 SW 20TH ST APT 3014
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8567
Practice Address - Country:US
Practice Address - Phone:352-671-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014312122300000X
FLHAD 561223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist