Provider Demographics
NPI:1073206454
Name:KROISS, REILLY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:REILLY
Middle Name:LYNN
Last Name:KROISS
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 1:5605 ZUMBRA DR
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7760
Mailing Address - Country:US
Mailing Address - Phone:952-693-3233
Mailing Address - Fax:
Practice Address - Street 1:5205 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1770
Practice Address - Country:US
Practice Address - Phone:952-472-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND148851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND14885OtherMINNESOTA BOARD OF DENTISTRY