Provider Demographics
NPI:1417173592
Name:GREY, KRISTINA A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:A
Last Name:GREY
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 E LAURELHURST DR NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5300
Mailing Address - Country:US
Mailing Address - Phone:206-526-7998
Mailing Address - Fax:
Practice Address - Street 1:18321 98TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3397
Practice Address - Country:US
Practice Address - Phone:425-485-9633
Practice Address - Fax:425-489-9810
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000079751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics