Provider Demographics
NPI:1376602896
Name:RIESTER, ANNA SEYKORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:SEYKORA
Last Name:RIESTER
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 1:5149 OLIVER AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1032
Mailing Address - Country:US
Mailing Address - Phone:612-925-5638
Mailing Address - Fax:
Practice Address - Street 1:800 LASALLE AVE
Practice Address - Street 2:#100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2006
Practice Address - Country:US
Practice Address - Phone:612-338-4546
Practice Address - Fax:612-338-2059
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice