Provider Demographics
NPI:1285830984
Name:NGUYEN, KRISTINE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:NGUYEN
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 1:215 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891
Mailing Address - Country:US
Mailing Address - Phone:607-535-7744
Mailing Address - Fax:607-535-4857
Practice Address - Street 1:215 7TH ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891
Practice Address - Country:US
Practice Address - Phone:607-535-7744
Practice Address - Fax:607-535-4857
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist