Provider Demographics
NPI:1225650146
Name:BAMBAREN, CHRISTINA (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BAMBAREN
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 1:8851 US HIGHWAY 19 N APT 1224
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5830
Mailing Address - Country:US
Mailing Address - Phone:954-391-1788
Mailing Address - Fax:
Practice Address - Street 1:33160 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3127
Practice Address - Country:US
Practice Address - Phone:727-324-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN25725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program