Healthcare Provider Details

I. General information

NPI: 1265319891
Provider Name (Legal Business Name): HANNAH RUTH KARTAK DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHICAGO AVE
MINNEAPOLIS MN
55407-1322
US

IV. Provider business mailing address

20680 JAGUAR AVE
LAKEVILLE MN
55044-7787
US

V. Phone/Fax

Practice location:
  • Phone: 612-823-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT193
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: