Provider Demographics
NPI:1437342821
Name:TARAN, KRISTY LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:TARAN
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 1:14421 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5821
Mailing Address - Country:US
Mailing Address - Phone:952-935-5212
Mailing Address - Fax:952-935-1391
Practice Address - Street 1:14421 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5821
Practice Address - Country:US
Practice Address - Phone:952-935-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95121223G0001X
MN133551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice