Healthcare Provider Details

I. General information

NPI: 1013321017
Provider Name (Legal Business Name): KATHRYN ELIZABETH KRAMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BAKER PARK RD SUITE 1040
MAPLE PLAIN MN
55359-9851
US

IV. Provider business mailing address

1400 BAKER PARK RD SUITE 1040
MAPLE PLAIN MN
55359-9851
US

V. Phone/Fax

Practice location:
  • Phone: 763-402-7003
  • Fax: 763-447-3208
Mailing address:
  • Phone: 763-402-7003
  • Fax: 763-447-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD13426
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7144
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: