Provider Demographics
NPI:1801959242
Name:ROSENTHAL, KRISTINE CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:CAROL
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:CAROL
Other - Last Name:DACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10015 PLEASURE CREEK CIR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4233
Mailing Address - Country:US
Mailing Address - Phone:763-784-0635
Mailing Address - Fax:
Practice Address - Street 1:15785 95TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4404
Practice Address - Country:US
Practice Address - Phone:763-420-5484
Practice Address - Fax:763-420-5875
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice