Provider Demographics
NPI:1245654243
Name:EVANS, KRYSTAL BROOKE (RDH, RDA)
Entity type:Individual
Prefix:MISS
First Name:KRYSTAL
Middle Name:BROOKE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 STELLA LINK RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3931
Mailing Address - Country:US
Mailing Address - Phone:713-375-1777
Mailing Address - Fax:832-383-0022
Practice Address - Street 1:9113 STELLA LINK RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3931
Practice Address - Country:US
Practice Address - Phone:713-375-1777
Practice Address - Fax:832-383-0022
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18757124Q00000X
TX36830126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant