Provider Demographics
NPI:1245631787
Name:KILBURG, CRISTINA
Entity type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:KILBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 143RD ST
Mailing Address - Street 2:406
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7994
Mailing Address - Country:US
Mailing Address - Phone:563-505-1296
Mailing Address - Fax:
Practice Address - Street 1:1701 W 143RD ST
Practice Address - Street 2:406
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7994
Practice Address - Country:US
Practice Address - Phone:563-505-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist