Provider Demographics
NPI:1689179368
Name:PICHE, KRISTIN ANDREA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANDREA
Last Name:PICHE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 N POINT PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8808
Mailing Address - Country:US
Mailing Address - Phone:770-664-4936
Mailing Address - Fax:
Practice Address - Street 1:4205 N POINT PKWY STE C
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8808
Practice Address - Country:US
Practice Address - Phone:770-664-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN0156701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program