Provider Demographics
NPI:1356433346
Name:KEHL, LOIS J (DDS)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:KEHL
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 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 189S
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-332-7474
Mailing Address - Fax:651-332-7475
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 189S
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:651-332-7474
Practice Address - Fax:651-332-7475
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24A16KEOtherBLUE CROSS
MN296025700Medicaid
MN43-41300OtherMEDICA
MN1011992OtherPREFERRED ONE
MN24A16KEOtherBLUE CROSS
MN43-41300OtherMEDICA