MEDICARE: KRISTA LEE KUDRNA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D12412	MN

General Provider Information

NPI Number	:	1780886176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA LEE KUDRNA DDS

Provider Business Mailing Address
First Line	:	1222 N FRONTAGE RD
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2359
Country	:	US
Telephone Number	:	651-437-3256
Fax Number	:	651-437-6488

Provider Business Practice Location Address
First Line	:	1222 N FRONTAGE RD
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2359
Country	:	US
Telephone Number	:	651-437-3256
Fax Number	:	651-437-6488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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