Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00009618 | FL |
NPI | 1053914804 |
---|---|
Provider Name | Teresa Kriston |
First Address | Trinity, FL 34655-5133 |
Second Address | Tarpon Springs, FL 34689-5111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |