Provider Demographics
NPI:1497125322
Name:KRAUSE SMILES PA
Entity type:Organization
Organization Name:KRAUSE SMILES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-742-1688
Mailing Address - Street 1:560 RIVERSIDE DR
Mailing Address - Street 2:SUITE A205
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4700
Mailing Address - Country:US
Mailing Address - Phone:410-742-1688
Mailing Address - Fax:
Practice Address - Street 1:560 RIVERSIDE DR
Practice Address - Street 2:SUITE A205
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4700
Practice Address - Country:US
Practice Address - Phone:410-742-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty