Provider Demographics
NPI:1245408095
Name:BECHARD, KRISTINE KAYE (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAYE
Last Name:BECHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:KAYE
Other - Last Name:MACHGAN (FORMER NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:620 7TH AVE W.
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736
Mailing Address - Country:US
Mailing Address - Phone:715-672-5261
Mailing Address - Fax:715-672-4918
Practice Address - Street 1:620 7TH AVE W.
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736
Practice Address - Country:US
Practice Address - Phone:715-834-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4490-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist