Provider Demographics
NPI:1922167055
Name:DURAN, KRISTA NENE (DDS)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:NENE
Last Name:DURAN
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 1:3344 SHOSHONE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3427
Mailing Address - Country:US
Mailing Address - Phone:919-672-6853
Mailing Address - Fax:
Practice Address - Street 1:1400 GROVE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2229
Practice Address - Country:US
Practice Address - Phone:303-825-2295
Practice Address - Fax:303-825-2244
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79751223G0001X
AZ71531223G0001X
CO10404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21430284Medicaid