Individual
JALISSA JOY KRUCKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
576 CHERRY DR, WACONIA, MN 55387
(952) 679-4461
Mailing address
576 CHERRY DR, WACONIA, MN 55387-4578
(952) 679-4461
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12793
MN
Other
Enumeration date
06/28/2010
Last updated
07/16/2018
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