NPIMap

Organization Active NPI

Daniel W Krueger Aas PC

  • Dentist
  • West Lafayette, IN
National Provider Identifier
1508931205
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12010165 Issued in IN
Legal business name
DANIEL W KRUEGER AAS PC
Practice address
928 N Robinson
Lifesmile Dentistry
West Lafayette, IN 47906-2766
Phone
(765) 743-3779
Fax
(765) 743-8767
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Dr. Daniel W Krueger, DDSNPI 1871531228
Title
Owner President
Phone
(765) 743-3779

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 12010165A IN
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 12010165 IN Primary

Addresses

Primary practice location

928 N Robinson
Lifesmile Dentistry
West Lafayette, IN 47906-2766

Mailing address

928 N Robinson
West Lafayette, IN 47906-2766
Phone (765) 743-3779

Other identifiers 1

IdentifierTypeStateIssuer
200270720BMedicaidIN

Other names 1

  • LifeSmiles Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

928 Robinson St
West Lafayette, IN 47906
Phone (765) 743-3779

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1508931205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 N ROBINSON",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479062766",
            "telephone_number": "765-743-3779",
            "fax_number": "765-743-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 N ROBINSON",
            "address_2": "LIFESMILE DENTISTRY",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479062766",
            "telephone_number": "765-743-3779",
            "fax_number": "765-743-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL W KRUEGER AAS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "765-743-3779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010165A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200270720B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeSmiles Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.