Provider Demographics
NPI:1154484954
Name:KRYSTEK, HOLLY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:KRYSTEK
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 1:2920 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2206
Mailing Address - Country:US
Mailing Address - Phone:563-263-9082
Mailing Address - Fax:563-263-7984
Practice Address - Street 1:2920 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761
Practice Address - Country:US
Practice Address - Phone:563-263-9082
Practice Address - Fax:563-263-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1180828Medicaid