Krystal Dawn Declerck, D.D.S.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

RES.2951 Issued in OH

Practice address

3000 Arlington Ave
Graduate Medical Education, Ms 1050
Toledo, OH 43614-2595

Phone

(419) 383-4244

Fax

(419) 383-3108

NPI assigned

Jun 24, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277337600000",
    "number": "1902117807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 ARLINGTON AVE",
            "address_2": "GRADUATE MEDICAL EDUCATION, MS 1050",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142595",
            "telephone_number": "419-383-4244",
            "fax_number": "419-383-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 ARLINGTON AVE",
            "address_2": "GRADUATE MEDICAL EDUCATION, MS 1050",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142595",
            "telephone_number": "419-383-4244",
            "fax_number": "419-383-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECLERCK",
        "first_name": "KRYSTAL",
        "middle_name": "DAWN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-24",
        "last_updated": "2010-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "RES.2951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos A, Decarvalho, M.D.
• Jai-Charles Decembly
• Brianna Dechristopher
• David Colin Decker, RPH
• Emily Decker
• Anna Declercq, PA-C
• Romain Decrop
• Nicole Irene Deehr
• Robert Deemer
• Deep Roots Family Therapy

• Student in an Organized Health Care Education/Training Program in Toledo, OH
• Providers in Toledo, OH by specialty
• Student in an Organized Health Care Education/Training Program in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.