Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11098 | MN |
NPI | 1003983107 |
---|---|
Provider Name | Dr. Kindra L Bratteig |
First Address | Lindstrom, MN 55045-9550 |
Second Address | Lindstrom, MN 55045-9550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 20/01/2021 |