Mark David Krull, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901022619 Issued in MI

Practice address

13300 S West Bay Shore Dr Ste 1
Traverse City, MI 49684-5571

Phone

(231) 946-0207

NPI assigned

May 21, 2018

Sex

Male

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

Enrolled in MI

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

Locations

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.

• Harborside Dental PLLC

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1114563012
  NPD Authorized official
• Mark D. Krull DDS PLLC

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1891455267
  NPD Authorized official

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1902397425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8866 MANHATTAN N",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496855823",
            "telephone_number": "231-218-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 S WEST BAY SHORE DR STE 1",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845571",
            "telephone_number": "231-946-0207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Caberfae Hwy",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496609200",
            "country_code": "US",
            "telephone_number": "231-723-8272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRULL",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-21",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Kroll, DO
• Laura Elizabeth Kroll
• Margaret Kristen Kroll, AU.D.
• Paul L Kropf, O.D.
• Rebecca Ann Krouskop
• Mary Margaret Krzystowczyk, NP
• Pamela Anne Kucharczyk, PHARMD
• Kimberly Kucharski, LLMSW
• Amy P Kudary, P.A.
• Ann K Kuenker, D.O.

• General Practice Dentistry in Traverse City, MI
• Providers in Traverse City, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.