Healthcare Provider Details

I. General information

NPI: 1780886176
Provider Name (Legal Business Name): KRISTA LEE KUDRNA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 N FRONTAGE RD
HASTINGS MN
55033-2359
US

IV. Provider business mailing address

1222 N FRONTAGE RD
HASTINGS MN
55033-2359
US

V. Phone/Fax

Practice location:
  • Phone: 651-437-3256
  • Fax: 651-437-6488
Mailing address:
  • Phone: 651-437-3256
  • Fax: 651-437-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12412
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: