Provider Demographics
NPI:1043400674
Name:NEWSOM, KRISTIN L (DDS, MS, INC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:DDS, MS, INC
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4260 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-461-1182
Mailing Address - Fax:805-461-5162
Practice Address - Street 1:4260 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-461-1182
Practice Address - Fax:805-461-5162
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry