Provider Demographics
NPI:1467113514
Name:KRISTIN KAELIN, DMD, P.C.
Entity Type:Organization
Organization Name:KRISTIN KAELIN, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-425-5110
Mailing Address - Street 1:100 TRIANGLE SHOPPING CTR STE 185
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4683
Mailing Address - Country:US
Mailing Address - Phone:360-425-5110
Mailing Address - Fax:
Practice Address - Street 1:100 TRIANGLE SHOPPING CTR STE 185
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4683
Practice Address - Country:US
Practice Address - Phone:360-425-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty