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General NPI Number Information
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NPI Number | 1912874926
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Entity Type | Organization
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Legal Business Name | CROSBY FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 107 W MAIN ST
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City | CROSBY
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State | MN
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Zip | 56441-1423
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Country | US
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Telephone | 218-252-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 2665 FARRINGTON ST
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City | ROSEVILLE
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State | MN
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Zip | 55113-2404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | KIEFER MILLER
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Credential | DDS
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Telephone | 218-252-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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