MEDICARE: MRS. KRISHNA KATIRA

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	1223G0001X	General Practice Dentistry	D13828	MN

General Provider Information

NPI Number	:	1558802728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISHNA KATIRA

Provider Business Mailing Address
First Line	:	501 RIVER ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2512
Country	:	US
Telephone Number	:	646-918-4464
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 2ND AVE S STE 250
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2170
Country	:	US
Telephone Number	:	612-338-4122
Fax Number	:

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	05/02/2024

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