Provider Demographics
NPI:1780236976
Name:WEBER, KYNDRA KAE (DDS)
Entity type:Individual
Prefix:DR
First Name:KYNDRA
Middle Name:KAE
Last Name:WEBER
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 1:3940 STONEBRIDGE DR N
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1640
Mailing Address - Country:US
Mailing Address - Phone:651-315-4206
Mailing Address - Fax:
Practice Address - Street 1:405 SIBLEY ST STE 240
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2976
Practice Address - Country:US
Practice Address - Phone:651-224-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist