Provider Demographics
NPI:1821302373
Name:MANNING, KRYSTA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTA
Middle Name:ELIZABETH
Last Name:MANNING
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 1:110 W ENT AVE
Mailing Address - Street 2:ATTN: 21 DS/SGDD - DENTAL CLINIC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1595
Mailing Address - Country:US
Mailing Address - Phone:719-556-1333
Mailing Address - Fax:719-556-1331
Practice Address - Street 1:110 W ENT AVE
Practice Address - Street 2:ATTN: 21 DS/SGDD - DENTAL CLINIC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1595
Practice Address - Country:US
Practice Address - Phone:719-556-2273
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice