Provider Demographics
NPI:1447140827
Name:ANDROS, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:ANDROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 GOLDEN OAK ST NE
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55046-5008
Mailing Address - Country:US
Mailing Address - Phone:612-756-4989
Mailing Address - Fax:612-756-4989
Practice Address - Street 1:400 4TH ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5089
Practice Address - Country:US
Practice Address - Phone:507-384-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH9620124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist