Provider Demographics
NPI:1891038527
Name:CESENA, KRISTINA MICHELLE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:CESENA
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 1:1708 CORDOVA DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4715
Mailing Address - Country:US
Mailing Address - Phone:310-490-6266
Mailing Address - Fax:
Practice Address - Street 1:1708 CORDOVA DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-4715
Practice Address - Country:US
Practice Address - Phone:310-490-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist