Provider Demographics
NPI:1558306191
Name:PAOLI, KRISTIN ANN (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:PAOLI
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 1:239 NORTHERN BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411
Mailing Address - Country:US
Mailing Address - Phone:570-587-5541
Mailing Address - Fax:570-585-5152
Practice Address - Street 1:239 NORTHERN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-587-5541
Practice Address - Fax:570-585-5152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030065L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00881083OtherUNITED CONCORDIA