Provider Demographics
NPI:1811023237
Name:TRI, KEVIN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:TRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 HWY 55
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2359
Mailing Address - Country:US
Mailing Address - Phone:651-437-1940
Mailing Address - Fax:651-437-9333
Practice Address - Street 1:1260 HWY 55
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2359
Practice Address - Country:US
Practice Address - Phone:651-437-1940
Practice Address - Fax:651-437-9333
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN810238OtherUNITED CONCORDIA INS CO