Provider Demographics
NPI:1417418690
Name:LILL, KRISTA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:JEAN
Last Name:LILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:JEAN
Other - Last Name:DEVEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7701 YORK AVE S STE 240
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5896
Mailing Address - Country:US
Mailing Address - Phone:952-234-7305
Mailing Address - Fax:
Practice Address - Street 1:7701 YORK AVE S STE 240
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5896
Practice Address - Country:US
Practice Address - Phone:952-234-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist