Provider Demographics
NPI:1275010670
Name:SCHULTE, KRISTA CIARRA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:CIARRA
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5035
Mailing Address - Country:US
Mailing Address - Phone:970-394-4763
Mailing Address - Fax:
Practice Address - Street 1:210 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7414
Practice Address - Country:US
Practice Address - Phone:619-701-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist