Provider Demographics
NPI:1013438118
Name:WINATA, KRISTY (DMD)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:WINATA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 CABOT ST # 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2515
Mailing Address - Country:US
Mailing Address - Phone:978-927-0324
Mailing Address - Fax:
Practice Address - Street 1:495 CABOT ST # 201
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2515
Practice Address - Country:US
Practice Address - Phone:978-927-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18576431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice