1285837443 NPI number — KRISTIE JANE TREPTOW D.D.S.

Table of content: KRISTIE JANE TREPTOW D.D.S. (NPI 1285837443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285837443 NPI number — KRISTIE JANE TREPTOW D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREPTOW
Provider First Name:
KRISTIE
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285837443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16955 TORONTO AVE SE
Provider Second Line Business Mailing Address:
#312
Provider Business Mailing Address City Name:
PRIOR LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55372-5537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-447-2438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 E MAPLE ST
Provider Second Line Business Practice Location Address:
BOX 275
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55943-0275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-896-2202
Provider Business Practice Location Address Fax Number:
507-896-3363
Provider Enumeration Date:
06/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D12420 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)