Gregory Michael Kraczkowsky, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11253 Issued in CT

Practice address

17 Lafayette St
Norwich, CT 06360-3407

Phone

(860) 886-2497

NPI assigned

Jun 26, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Norwich Family Dental Associates

  • General Practice Dentistry
  • Norwich, CT
  • NPI 1386755742
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1285074062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 LAFAYETTE ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063603407",
            "telephone_number": "860-886-2497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 LAFAYETTE ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063603407",
            "telephone_number": "860-886-2497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRACZKOWSKY",
        "first_name": "GREGORY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "11253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004011367",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004011136",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jyothirmayee Korivi, M. D.
• Kinneri Kothari, M.D.
• Ashok Kottarathara, MD
• Georgina Koutouzis, DO
• Kristen Tiffany Kowalski
• Hillary Kranc
• Chanel Krauth, LCSW
• Christine P. Krom, LPC
• Linda R Kronick, DMD
• Laura Krueger

• General Practice Dentistry in Norwich, CT
• Providers in Norwich, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.