Individual
FREDERICK CLYDE KRUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3015 NAVARRE AVE, SUITE A, OREGON, OH 43616-3398
(419) 693-8993
Mailing address
9350 SYLVANIA, SYLVANIA, OH 43560
(419) 829-6304
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14964
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0292062
—
OH
Enumeration date
05/01/2007
Last updated
07/28/2008
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