Individual
DR. KRISTIANNE VIDAL MACARAEG KRACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1304 LIBERTY PL, SICKLERVILLE, NJ 08081-5710
(856) 875-9550
Mailing address
2404 CHERRY ST, MANASQUAN, NJ 08736-1523
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS041678
PA
1223P0221X
Pediatric Dentistry
22DI02749000
NJ
1223P0221X
Pediatric Dentistry
Primary
DS041678
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/26/2017
Last updated
01/30/2023
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