Provider Demographics
NPI:1902015092
Name:KREEKOS, MICHAEL G
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:KREEKOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11836 ELM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4438
Mailing Address - Country:US
Mailing Address - Phone:402-334-0328
Mailing Address - Fax:
Practice Address - Street 1:11836 ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4438
Practice Address - Country:US
Practice Address - Phone:402-334-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice