Krista L. Kukarans, DDS
Individual provider Active NPI Dentist · Cook, MN
NPI 1801087879 · NPPES record last updated Jan 25, 2021
Key facts
- NPI
- 1801087879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D14505 (MN)
- Practice address
- 20 5TH St SE
Cook, MN 55723-9702 - Phone
- (218) 666-5941
- Fax
- (218) 666-5099
- NPI assigned
- Aug 6, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151230000958 | IL | Order and Referring Only - Dentist |
9436451960 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14505 | MN | MD | Dentist |
Interoperability endpoints
- krista.kukaransdds.p29@direct.fhn-fqhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14505 | MN | Yes |
| General Practice Dentistry | 1223G0001X | 6157 | WI |
Addresses
Primary practice location
20 5TH St SE
Cook, MN 55723-9702
Mailing address
20 5TH St SE
Cook, MN 55723-9702
Phone (218) 666-5941
Other providers in Cook, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.