Dr. Jack Issac Krajekian, D.M.D.
Dentist, Oral and Maxillofacial Surgery in Charleston, WV. Individual provider (NPI-1).
Details
- NPI
- 1790768562
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jack Issac Krajekian
- Credential
- D.M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 25, 2005
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 116 | WV | Yes |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 3542 | WV | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | DS036241 | PA | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 19714 | MA |
Practice location
1215 Virginia St ECharleston, WV 25301-2908
Phone 304-345-1092 · Fax 304-345-1095
Mailing address
1215 Virginia St ECharleston, WV 25301-2908
Phone 304-345-1092 · Fax 304-345-1095
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 15 Oral and Maxillofacial Surgery (Dentist) providers in Charleston · All 9,831 providers in Charleston
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