Provider Demographics
NPI:1487735064
Name:KRAKOWER, THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:KRAKOWER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:STE 2304
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5136
Mailing Address - Country:US
Mailing Address - Phone:610-744-2888
Mailing Address - Fax:610-744-2832
Practice Address - Street 1:1068 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 2304 RIDDLE HEALTH CARE CENTER II
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5104
Practice Address - Country:US
Practice Address - Phone:610-744-2888
Practice Address - Fax:610-744-2832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDS018722L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT82099Medicare UPIN