Provider Demographics
NPI:1649561440
Name:MADDUX, KRISTEN ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:MADDUX
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 1:1169 NIMMO PKWY STE 242
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7760
Mailing Address - Country:US
Mailing Address - Phone:703-855-8192
Mailing Address - Fax:
Practice Address - Street 1:1169 NIMMO PKWY STE 242
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-7760
Practice Address - Country:US
Practice Address - Phone:703-855-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40071223G0001X
VA04014148141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice