MEDICARE: CRISSTILL ANN DUASO RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H11951	MN

General Provider Information

NPI Number	:	1508704081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISSTILL ANN DUASO RDH

Provider Business Mailing Address
First Line	:	505 25TH AVE SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-5259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 N AUGUSTA CT STE 108
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7719
Country	:	US
Telephone Number	:	507-625-7172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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