Provider Demographics
NPI:1073060877
Name:FORTE, KRISTIN RENEE (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:FORTE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9302
Mailing Address - Country:US
Mailing Address - Phone:814-558-5285
Mailing Address - Fax:
Practice Address - Street 1:4545 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NY
Practice Address - Zip Code:14505-9302
Practice Address - Country:US
Practice Address - Phone:814-558-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028856-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist