Provider Demographics
NPI:1245072602
Name:SCHNEIDER, KRISTINE JO-ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE JO-ANNE
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KRISTINE JO-ANNE
Other - Middle Name:
Other - Last Name:TIBAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 121ST AVE NE APT 107
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-5069
Mailing Address - Country:US
Mailing Address - Phone:916-662-6046
Mailing Address - Fax:
Practice Address - Street 1:4219 S OTHELLO ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3892
Practice Address - Country:US
Practice Address - Phone:206-316-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615659571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice