Provider Demographics
NPI:1356368120
Name:OKANE, KRISTI CASEY (DDS)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:CASEY
Last Name:OKANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:CASEY-OKANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2221 FORD PKWY
Mailing Address - Street 2:STE #201
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116
Mailing Address - Country:US
Mailing Address - Phone:651-698-1242
Mailing Address - Fax:651-696-1858
Practice Address - Street 1:2221 FORD PKWY
Practice Address - Street 2:STE #201
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:651-698-1242
Practice Address - Fax:651-696-1858
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist