Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 55823 | CA |
NPI | 1043400674 |
---|---|
Provider Name | Dr. Kristin L. Newsom |
First Address | Atascadero, CA 93422 |
Second Address | Atascadero, CA 93422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 06/09/2013 |