Provider Demographics
NPI:1619097532
Name:KRAFCISIN, PETRO STEFAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PETRO
Middle Name:STEFAN
Last Name:KRAFCISIN
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 1:6216 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1103
Mailing Address - Country:US
Mailing Address - Phone:708-430-0007
Mailing Address - Fax:708-430-1320
Practice Address - Street 1:6216 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1103
Practice Address - Country:US
Practice Address - Phone:708-430-0007
Practice Address - Fax:708-430-1320
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice