Provider Demographics
NPI:1023140118
Name:RUSSELL D DUNKEL & THOMAS KRAKLOW, DDS, INC
Entity type:Organization
Organization Name:RUSSELL D DUNKEL & THOMAS KRAKLOW, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-427-8565
Mailing Address - Street 1:4154 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1906
Mailing Address - Country:US
Mailing Address - Phone:414-427-8565
Mailing Address - Fax:414-427-8590
Practice Address - Street 1:4154 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1906
Practice Address - Country:US
Practice Address - Phone:414-427-8565
Practice Address - Fax:414-427-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2913122300000X
WI3931122300000X
WI50011941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487768578OtherNPI
WI1225054265OtherNPI
WI1811001902OtherNPI