Provider Demographics
NPI:1104181288
Name:GIVAN, KRISTIN RISHODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:RISHODD
Last Name:GIVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 WISTERIA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-4604
Mailing Address - Country:US
Mailing Address - Phone:678-836-2107
Mailing Address - Fax:
Practice Address - Street 1:2220 WISTERIA DR STE 300
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4604
Practice Address - Country:US
Practice Address - Phone:678-836-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0159261223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program