Provider Demographics
NPI:1457471484
Name:DENNINGTON, KRISTINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:DENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 SODA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9255
Mailing Address - Country:US
Mailing Address - Phone:469-371-9075
Mailing Address - Fax:
Practice Address - Street 1:630 N KIMBALL AVENUE
Practice Address - Street 2:STE #100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9255
Practice Address - Country:US
Practice Address - Phone:817-421-8777
Practice Address - Fax:817-421-4388
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350829ZGUYMedicare PIN