Individual
DR. DIANE VAVRIK CRATER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8063 HADLEY AVE S, COTTAGE GROVE, MN 55016-2652
(651) 459-4894
(651) 458-4940
Mailing address
8063 HADLEY AVE S, COTTAGE GROVE, MN 55016-2652
(651) 459-4894
(651) 458-4940
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9628
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1151079
MN TAX ID
—
01
—
2167963000
MN UI
—
Enumeration date
05/20/2006
Last updated
07/08/2007
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