Provider Demographics
NPI:1609039494
Name:DAVIS, KRISTI ANN (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MONTE VILLA CT
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7092
Mailing Address - Country:US
Mailing Address - Phone:408-646-1048
Mailing Address - Fax:
Practice Address - Street 1:146 MONTE VILLA CT
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7092
Practice Address - Country:US
Practice Address - Phone:408-646-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist