Provider Demographics
NPI:1558802728
Name:KATIRA, KRISHNA
Entity type:Individual
Prefix:MRS
First Name:KRISHNA
Middle Name:
Last Name:KATIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2512
Mailing Address - Country:US
Mailing Address - Phone:646-918-4464
Mailing Address - Fax:
Practice Address - Street 1:250 2ND AVE S STE 250
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2170
Practice Address - Country:US
Practice Address - Phone:612-338-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice