Provider Demographics
NPI:1316190416
Name:TRANDEM, KIRSTEN CECELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:CECELIA
Last Name:TRANDEM
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 1:4213 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6013
Mailing Address - Country:US
Mailing Address - Phone:631-544-6449
Mailing Address - Fax:
Practice Address - Street 1:4213 KACHINA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6013
Practice Address - Country:US
Practice Address - Phone:631-544-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25527122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist