Individual
DR. KRISTIN H KENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
501 5TH AVE SE, DEVILS LAKE, ND 58301-3621
(701) 662-4141
(701) 662-7582
Mailing address
501 5TH AVE SE, DEVILS LAKE, ND 58301-3621
(701) 662-4141
(701) 662-7582
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1736
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1736
STATE LICENSE NUMBER
ND
05
—
40953
—
ND
01
—
842354
UNITED CONCORDIA INS
ND
01
—
901736
DENTAL SERVICE CORP ID
ND
Enumeration date
05/08/2007
Last updated
07/08/2007
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