Provider Demographics
NPI:1689307100
Name:PERSON, KRISTIANA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:
Last Name:PERSON
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 1:1867 JONESBORO RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6099
Mailing Address - Country:US
Mailing Address - Phone:678-432-0209
Mailing Address - Fax:
Practice Address - Street 1:1867 JONESBORO RD STE 6
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6099
Practice Address - Country:US
Practice Address - Phone:678-423-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227631223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice