Provider Demographics
NPI:1164669750
Name:LEIDEMANN, KRISTI S (RDH)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:S
Last Name:LEIDEMANN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:S
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 7291
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:60 SECOND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6853
Practice Address - Country:US
Practice Address - Phone:207-755-3456
Practice Address - Fax:207-755-3457
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY51 024362124Q00000X
TN6417124Q00000X
MERDH2901124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist