Provider Demographics
NPI:1851592562
Name:CRISPIN, KRISTI ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANN
Last Name:CRISPIN
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 1:18981 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3237
Mailing Address - Country:US
Mailing Address - Phone:818-758-3557
Mailing Address - Fax:818-758-3559
Practice Address - Street 1:18981 VENTURA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3237
Practice Address - Country:US
Practice Address - Phone:818-758-3557
Practice Address - Fax:818-758-3559
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist