Provider Demographics
NPI:1639637986
Name:PLEASANT, KRISTY CHANELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:CHANELLE
Last Name:PLEASANT
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 1:30620 PAULINE AVE
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6266
Mailing Address - Country:US
Mailing Address - Phone:615-674-9131
Mailing Address - Fax:
Practice Address - Street 1:69160 RAMON RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-9140
Practice Address - Country:US
Practice Address - Phone:615-674-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA105243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program