Provider Demographics
NPI:1710144357
Name:CUMMINGS, KRISTEN MARY (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARY
Last Name:CUMMINGS
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 1:322 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5350
Mailing Address - Country:US
Mailing Address - Phone:636-477-1200
Mailing Address - Fax:636-922-4455
Practice Address - Street 1:322 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5350
Practice Address - Country:US
Practice Address - Phone:636-477-1200
Practice Address - Fax:636-922-4455
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040181741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry