Healthcare Provider Details

I. General information

NPI: 1457799884
Provider Name (Legal Business Name): KATIE KREMER JOHNSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 E MINNESOTA ST
SAINT JOSEPH MN
56374-8618
US

IV. Provider business mailing address

22 17TH AVE N
COLD SPRING MN
56320-4595
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-7729
  • Fax:
Mailing address:
  • Phone: 320-290-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13247
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: