Provider Demographics
NPI:1255725115
Name:GUPTILL, KRISTEN (DDS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GUPTILL
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 1:195 POTTER RD W
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8525
Mailing Address - Country:US
Mailing Address - Phone:917-744-1078
Mailing Address - Fax:
Practice Address - Street 1:2815 GARFIELD RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5005
Practice Address - Country:US
Practice Address - Phone:231-947-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058841223G0001X
MI2901022840122300000X
ND2295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice