Provider Demographics
NPI:1285837443
Name:TREPTOW, KRISTIE JANE (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:JANE
Last Name:TREPTOW
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 1:16955 TORONTO AVE SE
Mailing Address - Street 2:#312
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-5537
Mailing Address - Country:US
Mailing Address - Phone:952-447-2438
Mailing Address - Fax:
Practice Address - Street 1:109 E MAPLE ST
Practice Address - Street 2:BOX 275
Practice Address - City:HOUSTON
Practice Address - State:MN
Practice Address - Zip Code:55943-0275
Practice Address - Country:US
Practice Address - Phone:507-896-2202
Practice Address - Fax:507-896-3363
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12420122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program