Provider Demographics
NPI:1689116188
Name:BALLER, KRISTI ANN (RDH)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:ANN
Last Name:BALLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 10 BOX 119
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09142-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL DENTAL CLINIC
Practice Address - Street 2:LANGWIEDENERSTR BLDG. 3703
Practice Address - City:LANDSTUHL-KIRCHBERG
Practice Address - State:RP
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:063-719-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205622124Q00000X
CODH.002024577124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist