Provider Demographics
NPI:1629398532
Name:ENGELBREKTSON, KARA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:A
Last Name:ENGELBREKTSON
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 1:2251 CONNECTICUT AVE S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56337-4772
Mailing Address - Country:US
Mailing Address - Phone:320-253-5824
Mailing Address - Fax:320-203-2076
Practice Address - Street 1:2251 CONNECTICUT AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4772
Practice Address - Country:US
Practice Address - Phone:320-253-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNUNKNOWN390200000X
MND12820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program