Individual
DR. KRISTIN HELEN BOTHUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
828 HAWTHORNE ST E, SAINT PAUL, MN 55106-3252
(651) 774-2959
Mailing address
828 HAWTHORN AVE EAST, ST. PAUL, MN 55106-4183
(651) 774-2959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12443
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C12443
LICENSE NUMBER
MN
Enumeration date
02/12/2008
Last updated
02/12/2008
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