Provider Demographics
NPI:1154488245
Name:FORSTER, KRISTEN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:FORSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:223 BROWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646
Mailing Address - Country:US
Mailing Address - Phone:701-824-2991
Mailing Address - Fax:
Practice Address - Street 1:223 BROWN AVENUE
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646
Practice Address - Country:US
Practice Address - Phone:701-824-2991
Practice Address - Fax:701-824-2750
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41381Medicaid