Provider Demographics
NPI:1063080836
Name:RIESTER, ANNA NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:NICOLE
Last Name:RIESTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 HENNEPIN AVE APT H1804
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1759
Mailing Address - Country:US
Mailing Address - Phone:507-398-5324
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE 390
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2121
Practice Address - Country:US
Practice Address - Phone:952-926-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist