Individual
SHANNON MARIE KRUCKEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
63407 130TH AVE, CLAREMONT, MN 55924-4656
(507) 319-6845
Mailing address
63407 130TH AVE, CLAREMONT, MN 55924-4656
(507) 319-6845
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6343
MN
Other
Enumeration date
09/14/2007
Last updated
11/16/2009
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