Provider Demographics
NPI:1154490472
Name:BINSTOCK, KATRINA (DDS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BINSTOCK
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:PO BOX 23029
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-0029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 LAKE ST E
Practice Address - Street 2:SUITE 216
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1657
Practice Address - Country:US
Practice Address - Phone:952-473-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND112221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice