Provider Demographics
NPI:1316009335
Name:RIEWER, KRISTINE M (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:RIEWER
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 517
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0517
Mailing Address - Country:US
Mailing Address - Phone:218-847-9214
Mailing Address - Fax:218-847-9215
Practice Address - Street 1:701 HIGHWAY 10 E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56502-0517
Practice Address - Country:US
Practice Address - Phone:218-847-9214
Practice Address - Fax:218-847-9215
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN372149300Medicaid