Provider Demographics
NPI:1023703253
Name:KUMAR, CHRISTINA MARIE (RDA, CDA, RDH, MSED)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KUMAR
Suffix:
Gender:F
Credentials:RDA, CDA, RDH, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 AVERY RANCH BLVD UNIT 1801
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4013
Mailing Address - Country:US
Mailing Address - Phone:234-232-0525
Mailing Address - Fax:
Practice Address - Street 1:14100 AVERY RANCH BLVD UNIT 1801
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4013
Practice Address - Country:US
Practice Address - Phone:234-232-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118990126800000X
TX26252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant