Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 58104 | CA |
NPI | 1104081512 |
---|---|
Provider Name | Dr. Kristina Lynne Langworthy |
First Address | San Francisco, CA 94122-1531 |
Second Address | San Francisco, CA 94122-1531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 24/11/2021 |