Provider Demographics
NPI:1902010507
Name:BRITTAIN, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3650
Practice Address - Country:US
Practice Address - Phone:954-385-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist