Individual
JACQUELINE RAE KRECKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
375 FULTON ST, FARMINGDALE, NY 11735-3454
(718) 250-8000
Mailing address
375 FULTON ST, FARMINGDALE, NY 11735-3454
(516) 249-1188
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
062044
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2020
Last updated
09/24/2021
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