Kruckman Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KRUCKMAN FAMILY DENTISTRY

Practice address

141 Depot Dr
Waconia, MN 55387-1874

Phone

(952) 679-4461

NPI assigned

Aug 18, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jalissa Kruckman, DDSNPI 1114238821

Title

Owner

Phone

(952) 679-4461

Specialties & licenses 1

Addresses

Other names 1

• Kruckman Family Dentistry Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jalissa Joy Kruckman, DDS

  • General Practice Dentistry
  • Waconia, MN
  • NPI 1114238821
  NPD Authorized official
• Taylor Sawyer

  • General Practice Dentistry
  • Waconia, MN
  • NPI 1235755687
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1457134785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 DEPOT DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871874",
            "telephone_number": "952-679-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 DEPOT DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871874",
            "telephone_number": "952-679-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRUCKMAN FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "KRUCKMAN",
        "authorized_official_first_name": "JALISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-679-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kruckman Family Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jason Kosmatka
• Alexandra Kothenbeutel
• Charity Kranz, DO
• Krista D Kranz, CNM
• Benjamin Dreyer Krehbiel, DO
• Jalissa Joy Kruckman, DDS
• Emily Kruger, LICSW
• Emily Kubat, DPT
• Lindsay Kugel
• Cassandra Kuntz, OTR/L

• Dental Clinic/Center in Waconia, MN
• Providers in Waconia, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.