Provider Demographics
NPI:1508027152
Name:LAKE HARRIMAN, KRISTINA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:M
Last Name:LAKE HARRIMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4112
Mailing Address - Country:US
Mailing Address - Phone:207-782-5308
Mailing Address - Fax:
Practice Address - Street 1:471 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4112
Practice Address - Country:US
Practice Address - Phone:207-782-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME40721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice