Provider Demographics
NPI:1346629052
Name:PARTIN-AGARWAL, KRISTIE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:LYNN
Last Name:PARTIN-AGARWAL
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 1:5525 MANSIONS BLFS
Mailing Address - Street 2:APT #716
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4101
Mailing Address - Country:US
Mailing Address - Phone:360-292-5887
Mailing Address - Fax:
Practice Address - Street 1:355TH MEDICAL GROUP
Practice Address - Street 2:4175 S. ALAMO AVE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707
Practice Address - Country:US
Practice Address - Phone:520-228-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9379316-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist