Provider Demographics
NPI:1003983107
Name:BRATTEIG, KINDRA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KINDRA
Middle Name:L
Last Name:BRATTEIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12245 LINDSTROM LN
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9550
Mailing Address - Country:US
Mailing Address - Phone:651-257-4471
Mailing Address - Fax:651-257-2017
Practice Address - Street 1:12245 LINDSTROM LN
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9550
Practice Address - Country:US
Practice Address - Phone:651-257-4471
Practice Address - Fax:651-257-2921
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist