Provider Demographics
NPI:1104205285
Name:KRISTO LTD
Entity Type:Organization
Organization Name:KRISTO LTD
Other - Org Name:KRISTO ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-5182
Mailing Address - Street 1:1460 10TH AVE
Mailing Address - Street 2:PO BOX 516
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-9342
Mailing Address - Country:US
Mailing Address - Phone:715-684-5858
Mailing Address - Fax:
Practice Address - Street 1:1460 10TH AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9342
Practice Address - Country:US
Practice Address - Phone:715-684-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty