Most Relevant Information
Provider Data
| NPI Number: | 1003002882 |
| Provider Name: | SHANNON MARIE KRUCKEBERG RDH |
| Entity Type: | Individual |
| Taxonomy Code: | 124Q00000X |
| Specialty: | Dental Hygienist |
| License Number: | H6343 |
Most Important Dates
| Enumeration Date: | 09/14/2007 |
| Last Updated: | 11/16/2009 |
Provider Practice Location
63407 130TH AVE
CLAREMONT
MN
559244656
Practice Location Phone/Fax
| Phone: | 5073196845 |
| Fax: |
Provider Mailing Location
63407 130TH AVE
CLAREMONT
MN
559244656
Provider Mailing Phone/Fax
| Phone: | 5073196845 |
| Fax: |