Provider Demographics
NPI:1760795488
Name:CORREA, KRISTIN BALIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:BALIUS
Last Name:CORREA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9807 MCSARA CT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5461
Mailing Address - Country:US
Mailing Address - Phone:251-626-9924
Mailing Address - Fax:251-626-9924
Practice Address - Street 1:9807 MCSARA COURT
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527
Practice Address - Country:US
Practice Address - Phone:251-626-9924
Practice Address - Fax:601-815-5837
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5906C11223P0221X
MS3558-10122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry