Provider Demographics
NPI:1386722411
Name:BILLMAN, KRISTINE SUE (RDH)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:SUE
Last Name:BILLMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 FORBROOK LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4423
Mailing Address - Country:US
Mailing Address - Phone:507-250-0229
Mailing Address - Fax:507-529-0435
Practice Address - Street 1:643 FORBROOK LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4423
Practice Address - Country:US
Practice Address - Phone:507-250-0229
Practice Address - Fax:507-529-0435
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH3646124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist