Provider Demographics
NPI:1942556410
Name:BEHNAM, KRISTINA YEKTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:YEKTA
Last Name:BEHNAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:YEKTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3448 VILLA LN STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6471
Mailing Address - Country:US
Mailing Address - Phone:925-348-5400
Mailing Address - Fax:
Practice Address - Street 1:3448 VILLA LN STE 102
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6471
Practice Address - Country:US
Practice Address - Phone:707-251-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6307122300000X
CA61932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist