Provider Demographics
NPI:1912088113
Name:CHROUST, KURT PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:PETER
Last Name:CHROUST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15180 CHIPPENDALE AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-1523
Mailing Address - Country:US
Mailing Address - Phone:651-423-1900
Mailing Address - Fax:651-423-6595
Practice Address - Street 1:15180 CHIPPENDALE AVE W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1523
Practice Address - Country:US
Practice Address - Phone:651-423-1900
Practice Address - Fax:651-423-6595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice