Provider Demographics
NPI:1326415100
Name:BILLINGSLEY, KRISTEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:BILLINGSLEY
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 1:1121 OTTAWA BEACH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2528
Mailing Address - Country:US
Mailing Address - Phone:812-212-9413
Mailing Address - Fax:
Practice Address - Street 1:1121 OTTAWA BEACH RD STE 100
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2528
Practice Address - Country:US
Practice Address - Phone:616-288-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016012521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice