Provider Demographics
NPI:1750305140
Name:KRISTOFF, DAVID J (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:KRISTOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N RANGE LINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1469
Mailing Address - Country:US
Mailing Address - Phone:317-846-3436
Mailing Address - Fax:317-846-3596
Practice Address - Street 1:1040 N RANGE LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1469
Practice Address - Country:US
Practice Address - Phone:317-846-3436
Practice Address - Fax:317-846-3596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice