Provider Demographics
NPI:1437302197
Name:PATE, KRISTEN B (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:B
Last Name:PATE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 E 86TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6860
Mailing Address - Country:US
Mailing Address - Phone:317-575-2888
Mailing Address - Fax:317-575-2898
Practice Address - Street 1:860 E 86TH ST STE 1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6860
Practice Address - Country:US
Practice Address - Phone:317-575-2888
Practice Address - Fax:317-575-2898
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009695A122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist