Provider Demographics
NPI:1558979948
Name:MONTEMALE, KRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MONTEMALE
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 1:2404 WILTON DR
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1251
Mailing Address - Country:US
Mailing Address - Phone:954-418-2657
Mailing Address - Fax:
Practice Address - Street 1:2404 WILTON DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1251
Practice Address - Country:US
Practice Address - Phone:954-440-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-253761223G0001X
IDD-51871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice