Provider Demographics
NPI:1245793678
Name:AHLMAN, KAI ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:ANTHONY
Last Name:AHLMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15514 FLYBOAT LN
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6021
Mailing Address - Country:US
Mailing Address - Phone:952-220-1894
Mailing Address - Fax:
Practice Address - Street 1:12745 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9585
Practice Address - Country:US
Practice Address - Phone:651-257-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND141871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program