Provider Demographics
NPI:1407851694
Name:DEXTER, CRYSTAL M (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 SPRINGBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5841
Mailing Address - Country:US
Mailing Address - Phone:763-780-9155
Mailing Address - Fax:
Practice Address - Street 1:9055 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5841
Practice Address - Country:US
Practice Address - Phone:763-780-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0125449OtherMEDICA
MN6610246OtherMEDICA URGENT CARE
WI34413400Medicaid
MNHP39823OtherHEALTHPARTNERS
MN1035384OtherPREFERRED ONE
MN180463OtherUCARE MN
MN495L6FUOtherBCBS OF MN
MN762614200Medicaid
MN180463OtherUCARE MN
MN762614200Medicaid