Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS038518 | PA |
NPI | 1023243839 |
---|---|
Provider Name | Dr. Daniel Tyler Kratzer |
First Address | Allentown, PA 18104-6172 |
Second Address | Allentown, PA 18104-6172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 29/12/2010 |