Provider Demographics
NPI:1548489610
Name:KRUEGER, DOUGLAS ALAN (DDSS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:DDSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E 1ST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1501
Mailing Address - Country:US
Mailing Address - Phone:920-734-2414
Mailing Address - Fax:920-734-8722
Practice Address - Street 1:821 E 1ST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1501
Practice Address - Country:US
Practice Address - Phone:920-734-2414
Practice Address - Fax:920-734-8722
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1212 G. WIS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist