Provider Demographics
NPI:1235451816
Name:KRUEGER, CONNIE (RDH)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NORTH BROADWAY NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 NORTH BROADWAY, NE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906
Practice Address - Country:US
Practice Address - Phone:507-424-4199
Practice Address - Fax:507-529-4101
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7374124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist