Provider Demographics
NPI:1033296579
Name:TEIGEN, KRISTIN RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:RAE
Last Name:TEIGEN
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 1:4015 STEELE AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5521
Mailing Address - Country:US
Mailing Address - Phone:605-225-0261
Mailing Address - Fax:605-225-5305
Practice Address - Street 1:4015 STEELE AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6148
Practice Address - Country:US
Practice Address - Phone:605-225-0261
Practice Address - Fax:605-225-5305
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND999529OtherDENTAL SERVICE CORP OF ND
SD7801430Medicaid