Provider Demographics
NPI:1407488075
Name:KRISTO LTD
Entity Type:Organization
Organization Name:KRISTO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SUPPORT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-598-7473
Mailing Address - Street 1:3902 OAKWOOD HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7780
Mailing Address - Country:US
Mailing Address - Phone:715-598-7473
Mailing Address - Fax:
Practice Address - Street 1:440 CHESTNUT ST # 100
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4807
Practice Address - Country:US
Practice Address - Phone:715-421-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTO LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty