Provider Demographics
NPI:1568793768
Name:ROSENBROOK, CRYSTAL JANE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JANE
Last Name:ROSENBROOK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:JANE
Other - Last Name:BAURES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3194 LEYLAND TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3558
Mailing Address - Country:US
Mailing Address - Phone:715-559-6638
Mailing Address - Fax:
Practice Address - Street 1:3194 LEYLAND TRL
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3558
Practice Address - Country:US
Practice Address - Phone:715-559-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10573-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist