Provider Demographics
NPI:1073032330
Name:SMITS, KRISTIN JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JOY
Last Name:SMITS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10458 VIVIENDA ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1753
Mailing Address - Country:US
Mailing Address - Phone:805-722-7187
Mailing Address - Fax:
Practice Address - Street 1:10458 VIVIENDA ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-1753
Practice Address - Country:US
Practice Address - Phone:805-722-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice