Provider Demographics
NPI:1689018541
Name:BURCH, KRISTIN CARAZOLA (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CARAZOLA
Last Name:BURCH
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 1:4854 RIDGEMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1742
Mailing Address - Country:US
Mailing Address - Phone:727-789-8900
Mailing Address - Fax:727-789-1029
Practice Address - Street 1:4854 RIDGEMOOR BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1742
Practice Address - Country:US
Practice Address - Phone:727-789-8900
Practice Address - Fax:727-789-1029
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist