Individual
BREANNA KRUCKEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
516 MAIN ST, MADISON LAKE, MN 56063-2027
(507) 243-3747
Mailing address
PO BOX 458, MADISON LAKE, MN 56063-0458
(507) 243-3747
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D009327
AZ
122300000X
Dentist
D13916
MN
1223G0001X
General Practice Dentistry
Primary
D13916
MN
Other
Enumeration date
10/22/2015
Last updated
03/13/2025
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