Active NPI
Frederick Clyde Kruse, DDS
- Dentist
- Oregon, OH
National Provider Identifier
1124249958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 14964
- Practice address
- 3015 Navarre Ave
Suite a
Oregon, OH 43616-3398 - Phone
- (419) 693-8993
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 14964 | OH | Primary |
Addresses
Primary practice location
3015 Navarre Ave
Suite a
Oregon, OH 43616-3398
Mailing address
9350 Sylvania
Sylvania, OH 43560
Phone (419) 829-6304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0292062 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14964 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1124249958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9350 SYLVANIA",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "43560",
"telephone_number": "419-829-6304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3015 NAVARRE AVE",
"address_2": "SUITE A",
"city": "OREGON",
"state": "OH",
"postal_code": "436163398",
"telephone_number": "419-693-8993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUSE",
"first_name": "FREDERICK",
"middle_name": "CLYDE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "14964",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0292062",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oregon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.