Provider Demographics
NPI:1710962626
Name:IRWIN, KRISTA COLLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:COLLEEN
Last Name:IRWIN
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 1:1 WARREN ST
Mailing Address - Street 2:APT 206
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3621
Mailing Address - Country:US
Mailing Address - Phone:617-610-6980
Mailing Address - Fax:
Practice Address - Street 1:CAMP CASEY DC
Practice Address - Street 2:618TH DC (AS) UNIT # 15658
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224-5658
Practice Address - Country:KR
Practice Address - Phone:0103-135-6980
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist