Provider Demographics
NPI:1205491834
Name:KALLIS, CHRISTINA (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:KALLIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:YIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:700 SW 78TH AVE APT 614
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3375
Mailing Address - Country:US
Mailing Address - Phone:786-219-8502
Mailing Address - Fax:
Practice Address - Street 1:3801 HOLLYWOOD BLVD STE 225
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6849
Practice Address - Country:US
Practice Address - Phone:954-573-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02752300122300000X
FL237361223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist