Provider Demographics
NPI:1831419209
Name:GOSSAI, KRISTA NOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:NOEL
Last Name:GOSSAI
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 1:2850 CURVE CREST BLVD W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4039
Mailing Address - Country:US
Mailing Address - Phone:651-439-9400
Mailing Address - Fax:
Practice Address - Street 1:2850 CURVE CREST BLVD W
Practice Address - Street 2:SUITE 200
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4039
Practice Address - Country:US
Practice Address - Phone:651-439-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice