Provider Demographics
NPI:1750675047
Name:SIEVERT, KRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:
Last Name:SIEVERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MOANA LN STE 7
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4959
Mailing Address - Country:US
Mailing Address - Phone:775-825-6655
Mailing Address - Fax:
Practice Address - Street 1:601 W MOANA LN STE 7
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4959
Practice Address - Country:US
Practice Address - Phone:775-825-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist