Provider Demographics
NPI:1114179371
Name:ANGWIN, KRISTEN LEE (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:ANGWIN
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 1:3417 GRAYSON CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-1912
Mailing Address - Country:US
Mailing Address - Phone:214-533-3089
Mailing Address - Fax:
Practice Address - Street 1:681 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7036
Practice Address - Country:US
Practice Address - Phone:214-533-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice