Provider Demographics
NPI:1083841621
Name:CRACKEL, MARY LOUISE TRUCHON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE TRUCHON
Last Name:CRACKEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:TRUCHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:303 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330
Mailing Address - Country:US
Mailing Address - Phone:763-441-9181
Mailing Address - Fax:763-269-8692
Practice Address - Street 1:4243 4TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-2113
Practice Address - Country:US
Practice Address - Phone:612-822-9030
Practice Address - Fax:612-821-2818
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND126941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice