Provider Demographics
NPI:1376825505
Name:KRESTOS, AMANDA LUCILE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LUCILE
Last Name:KRESTOS
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:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6626
Mailing Address - Fax:
Practice Address - Street 1:31775 STATE ROUTE 20 STE A3
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5104
Practice Address - Country:US
Practice Address - Phone:360-679-9216
Practice Address - Fax:360-679-9239
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614834861223G0001X
FL25534122300000X
ORD96171223G0001X
CADDS1014701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist