Provider Demographics
NPI:1578086948
Name:CRONIN, KAITLIN FAITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:FAITH
Last Name:CRONIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAITLIN
Other - Middle Name:FAITH
Other - Last Name:VICARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5545 PARISH TURN PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6770
Mailing Address - Country:US
Mailing Address - Phone:847-508-9330
Mailing Address - Fax:
Practice Address - Street 1:1301 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7105
Practice Address - Country:US
Practice Address - Phone:757-210-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012790A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist