Provider Demographics
NPI:1326828716
Name:STUM, ALI KRISTINA (RDH)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:KRISTINA
Last Name:STUM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 E WILLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1842
Mailing Address - Country:US
Mailing Address - Phone:435-215-6718
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 205
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6458
Practice Address - Country:US
Practice Address - Phone:435-652-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11331177-9926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist