Provider Demographics
NPI:1154464576
Name:WEST, KRISTINE SPRING (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:SPRING
Last Name:WEST
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:SPRING
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:13109 SCHAVEY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9015
Mailing Address - Country:US
Mailing Address - Phone:517-507-3001
Mailing Address - Fax:
Practice Address - Street 1:13109 SCHAVEY RD STE 1
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9015
Practice Address - Country:US
Practice Address - Phone:517-507-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056161-11223X0400X
MO0155241223X0400X
MI29010164401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty