Provider Demographics
NPI:1851518419
Name:BARTA, KRISTINA J
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:J
Last Name:BARTA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:J
Other - Last Name:BARTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11229 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2617
Mailing Address - Country:US
Mailing Address - Phone:402-593-9911
Mailing Address - Fax:402-593-0595
Practice Address - Street 1:11229 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2617
Practice Address - Country:US
Practice Address - Phone:402-593-9911
Practice Address - Fax:402-593-0595
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0560516Medicaid
NE10025205100Medicaid