Provider Demographics
NPI:1821155037
Name:ZITTERELL, KRISTEN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:ZITTERELL
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 1:104 DEAN ST
Mailing Address - Street 2:#103
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-5403
Mailing Address - Country:US
Mailing Address - Phone:508-692-9548
Mailing Address - Fax:
Practice Address - Street 1:104 DEAN ST
Practice Address - Street 2:#103
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-5403
Practice Address - Country:US
Practice Address - Phone:508-692-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0222521223G0001X
RIDEN029531223D0004X
MA18559241223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice