Provider Demographics
NPI:1407876212
Name:BANDOLA, KRYSTIN ANN (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTIN
Middle Name:ANN
Last Name:BANDOLA
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4693
Mailing Address - Country:US
Mailing Address - Phone:908-359-1067
Mailing Address - Fax:908-359-6467
Practice Address - Street 1:202 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4693
Practice Address - Country:US
Practice Address - Phone:908-359-1067
Practice Address - Fax:908-359-6467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1021548001223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology