Provider Demographics
NPI:1326390451
Name:WARREN, KRISTLE JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTLE
Middle Name:JEAN
Last Name:WARREN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KRISTLE
Other - Middle Name:JEAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1730 SE FLANDERS LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5077
Mailing Address - Country:US
Mailing Address - Phone:360-789-9040
Mailing Address - Fax:
Practice Address - Street 1:1730 SE FLANDERS LN
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5077
Practice Address - Country:US
Practice Address - Phone:360-789-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-13
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5781124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist