Provider Demographics
NPI:1942468087
Name:CHISOWSKY, KRISTY (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:CHISOWSKY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KERN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-2964
Mailing Address - Country:US
Mailing Address - Phone:912-882-1133
Mailing Address - Fax:
Practice Address - Street 1:204 KERN CT
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-2964
Practice Address - Country:US
Practice Address - Phone:912-882-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH009697124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH009697OtherHYGIENIST