Provider Demographics
NPI:1972723161
Name:KRISTAL, DAVID MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:KRISTAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:FORCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2737 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2218
Mailing Address - Country:US
Mailing Address - Phone:614-235-7474
Mailing Address - Fax:614-236-9993
Practice Address - Street 1:603 NORTH WAGGONER RD.
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004
Practice Address - Country:US
Practice Address - Phone:614-868-0977
Practice Address - Fax:614-868-9281
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics