Active NPI
Johhn J Krack, D.D.S.
- General Practice Dentistry
- Middle River, MD
National Provider Identifier
1124367479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10524
- Practice address
- 12412 Eastern Ave
Middle River, MD 21220-1308 - Phone
- (410) 335-7771
- NPI assigned
- Feb 6, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10524 | MD | Primary |
Addresses
Primary practice location
12412 Eastern Ave
Middle River, MD 21220-1308
Mailing address
PO Box B
Chase, MD 21027-0020
Phone (410) 335-7771
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 |
|---|---|---|---|
| 10524 | MD | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Avenue Dental, LLC | Past | Accepting new patients | |
| Schubert & Krack, D.S.S., P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Baltimore, MD
- NPI 1437550761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360108800000",
"number": "1124367479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX B",
"city": "CHASE",
"state": "MD",
"postal_code": "210270020",
"telephone_number": "410-335-7771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12412 EASTERN AVE",
"city": "MIDDLE RIVER",
"state": "MD",
"postal_code": "212201308",
"telephone_number": "410-335-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRACK",
"first_name": "JOHHN",
"middle_name": "J",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-06",
"last_updated": "2013-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "10524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middle River, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.