Breanna Kruckeberg, DMD is a
Dentist - General Practice based in Madison Lake, Minnesota. Breanna Kruckeberg is licensed to practice in Minnesota (license number D13916) and her current practice location is
516 Main St, Madison Lake, Minnesota. She can be reached at her office (for appointments etc.) via phone at
(507) 243-3747.
NPI number for Breanna Kruckeberg is 1518339118 and her current mailing address is Po Box 458, Madison Lake, Minnesota. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1518339118.
Healthcare Provider's Profile
| Full Name | Breanna Kruckeberg |
|---|
| Gender | Female |
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| Speciality | Dentist - General Practice |
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| Location | 516 Main St, Madison Lake, Minnesota |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1518339118
- Provider Enumeration Date: 10/22/2015
- Last Update Date: 03/13/2025
Medical Identifiers
Medical identifiers for Breanna Kruckeberg such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1518339118 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | D009327 (Arizona) | Secondary |
| 122300000X | Dentist | D13916 (Minnesota) | Secondary |
| 1223G0001X | Dentist - General Practice | D13916 (Minnesota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Breanna Kruckeberg is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Breanna Kruckeberg, DMD
Po Box 458,
Madison Lake, MN 56063-0458
Ph: (507) 243-3747 | Breanna Kruckeberg, DMD
516 Main St,
Madison Lake, MN 56063-2027
Ph: (507) 243-3747 |
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