Provider Demographics
NPI:1407424195
Name:VER WEIRE-HAISAN, KRISTINE M (RDH, BSDH, MPH (C))
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:VER WEIRE-HAISAN
Suffix:
Gender:F
Credentials:RDH, BSDH, MPH (C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835A S CENTRE CITY PKWY # 256
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6525
Mailing Address - Country:US
Mailing Address - Phone:760-803-6894
Mailing Address - Fax:
Practice Address - Street 1:50100 GOLSH RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5338
Practice Address - Country:US
Practice Address - Phone:769-803-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16328124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist