Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN12734 | FL |
NPI | 1003961871 |
---|---|
Provider Name | Dr. Jared T Krieger |
First Address | Heathrow, FL 32746-5333 |
Second Address | Altamonte Springs, FL 32701-6471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |