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Organization

STILLWATER MODERN DENTISTRY. PC

Active
Other names
Stillwater Modern Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTA JEAN KOEHLER (OWNER)
(651) 352-4629
Entity
Organization

Contact information

Practice address
13331 60TH ST N, OAK PARK HEIGHTS, MN 55082-1287
(651) 352-4629
(651) 359-2935
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
02/06/2023
Last updated
02/06/2023
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