Provider Demographics
NPI:1093807273
Name:VETTER, KRISTY KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:KATHLEEN
Last Name:VETTER
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 1:31371 NIGUEL RD
Mailing Address - Street 2:STE F
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4119
Mailing Address - Country:US
Mailing Address - Phone:949-248-5205
Mailing Address - Fax:949-487-7343
Practice Address - Street 1:31371 NIGUEL RD
Practice Address - Street 2:STE F
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4119
Practice Address - Country:US
Practice Address - Phone:949-248-5205
Practice Address - Fax:949-487-7343
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist