Robert T Kroepel, DDS
Individual provider Active NPI Dentist · Southold, NY
NPI 1114117199 · NPPES record last updated Jul 26, 2007
Key facts
- NPI
- 1114117199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 24532 (NY)
- Practice address
- 2360 Oaklawn Ave
Southold, NY 11971 - Phone
- (631) 765-2860
- NPI assigned
- Jul 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24532 | NY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 24532 | NY | Yes |
Addresses
Primary practice location
2360 Oaklawn Ave
Southold, NY 11971
Mailing address
PO Box 956
Southold, NY 11971-0930
Phone (631) 765-2860
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00387628 | Medicaid | NY |
Other providers in Southold, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.