Provider Demographics
NPI:1629234364
Name:POLDER, KRISTEL DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEL
Middle Name:DAWN
Last Name:POLDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD
Mailing Address - Street 2:STE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6203
Mailing Address - Country:US
Mailing Address - Phone:214-631-7546
Mailing Address - Fax:
Practice Address - Street 1:8201 PRESTON RD.
Practice Address - Street 2:STE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-631-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9581207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology