Provider Demographics
NPI:1487757464
Name:KRESHTOOL, DANIEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:KRESHTOOL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 W 13TH STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-652-3556
Mailing Address - Fax:302-654-8088
Practice Address - Street 1:1815 W 13TH STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-652-3556
Practice Address - Fax:302-654-8088
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE9191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001186708Medicaid
465282OtherUNITED CONCORDIA