Provider Demographics
NPI:1134417082
Name:RHOADES, KRISTINE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-3123
Mailing Address - Country:US
Mailing Address - Phone:307-941-0612
Mailing Address - Fax:
Practice Address - Street 1:17 S SENECA AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2816
Practice Address - Country:US
Practice Address - Phone:307-746-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6966122300000X
WY1301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist