Provider Demographics
NPI:1518351113
Name:BESEDA, KRISTA MICHEL ECKHOFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MICHEL ECKHOFF
Last Name:BESEDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:MICHEL
Other - Last Name:ECKHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:600 S AIRPORT RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6424
Mailing Address - Country:US
Mailing Address - Phone:303-776-3320
Mailing Address - Fax:
Practice Address - Street 1:600 S AIRPORT RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6424
Practice Address - Country:US
Practice Address - Phone:303-776-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN 00202775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program