Provider Demographics
NPI:1790031516
Name:ANAYA, KRYSTELLE NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTELLE
Middle Name:NICOLE
Last Name:ANAYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 TRAWOOD DR
Mailing Address - Street 2:STE D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4394
Mailing Address - Country:US
Mailing Address - Phone:915-855-1000
Mailing Address - Fax:
Practice Address - Street 1:3110 TRAWOOD DR
Practice Address - Street 2:STE D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4394
Practice Address - Country:US
Practice Address - Phone:915-855-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice