Provider Demographics
NPI:1609865914
Name:CRISS, JENNIFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CRISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 E STARR AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4327
Mailing Address - Country:US
Mailing Address - Phone:936-559-7200
Mailing Address - Fax:936-559-7221
Practice Address - Street 1:1602 E STARR AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4327
Practice Address - Country:US
Practice Address - Phone:936-559-7200
Practice Address - Fax:936-559-7221
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162183102Medicaid