Provider Demographics
NPI:1700042546
Name:STINE, RANAE M (RDH, ADT)
Entity type:Individual
Prefix:MS
First Name:RANAE
Middle Name:M
Last Name:STINE
Suffix:
Gender:F
Credentials:RDH, ADT
Other - Prefix:
Other - First Name:RANAE
Other - Middle Name:
Other - Last Name:STINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, DT
Mailing Address - Street 1:605 HILLCREST AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-5844
Mailing Address - Fax:
Practice Address - Street 1:605 HILLCREST AVE STE 210
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3680
Practice Address - Country:US
Practice Address - Phone:507-451-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT857124Q00000X
MNH6057124Q00000X
MNDT46125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist