Provider Demographics
NPI:1558956912
Name:BARRETT, KRISTINE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:BARRETT
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 1:220 W BRAMBLETON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1571
Mailing Address - Country:US
Mailing Address - Phone:757-583-1536
Mailing Address - Fax:757-583-3470
Practice Address - Street 1:220 W BRAMBLETON AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1571
Practice Address - Country:US
Practice Address - Phone:757-583-1536
Practice Address - Fax:757-583-3470
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417795122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty