Provider Demographics
NPI:1679721286
Name:HARTH, KRISTOPHER REX (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:REX
Last Name:HARTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOLANA RD STE A
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5229
Mailing Address - Country:US
Mailing Address - Phone:904-285-7711
Mailing Address - Fax:904-285-7895
Practice Address - Street 1:105 SOLANA RD STE A
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-5229
Practice Address - Country:US
Practice Address - Phone:904-285-7711
Practice Address - Fax:904-285-7895
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist