Provider Demographics
NPI:1669682845
Name:HARRISON, CRISTA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTA
Middle Name:KAY
Last Name:HARRISON
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 1:1275 PRIVATE ROAD 897
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-9071
Mailing Address - Country:US
Mailing Address - Phone:254-592-8828
Mailing Address - Fax:
Practice Address - Street 1:2299 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1701
Practice Address - Country:US
Practice Address - Phone:254-968-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190702401Medicaid