Provider Demographics
NPI:1093306417
Name:MEASNER, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MEASNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STUTTGART DENTAL CLINIC COMMAND
Mailing Address - Street 2:UNIT 30401
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STUTTGART DENTAL CLINIC COMMAND
Practice Address - Street 2:UNIT 30401
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09107
Practice Address - Country:US
Practice Address - Phone:801-650-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12116124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist