Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 012879 | MI |
NPI | 1003894577 |
---|---|
Provider Name | Dr. William L. Krieg |
First Address | St Clair Shores, MI 48080-2307 |
Second Address | St Clair Shores, MI 48080-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 08/07/2007 |