Healthcare Provider Details

I. General information

NPI: 1912088113
Provider Name (Legal Business Name): KURT PETER CHROUST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15180 CHIPPENDALE AVE W
ROSEMOUNT MN
55068-1523
US

IV. Provider business mailing address

15180 CHIPPENDALE AVE W
ROSEMOUNT MN
55068-1523
US

V. Phone/Fax

Practice location:
  • Phone: 651-423-1900
  • Fax: 651-423-6595
Mailing address:
  • Phone: 651-423-1900
  • Fax: 651-423-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9728
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: