Provider Demographics
NPI:1639251135
Name:ILIUTA, CRISTI ANA (DDS)
Entity Type:Individual
Prefix:
First Name:CRISTI ANA
Middle Name:
Last Name:ILIUTA
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 1:609 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-625-2040
Mailing Address - Fax:559-625-2797
Practice Address - Street 1:609 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-625-2040
Practice Address - Fax:559-636-8570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA692055OtherDENTICAL
CA1790991974OtherNPI PROCESSED WITH THE DENTI-CAL PROGRAM