Provider Demographics
NPI:1295489151
Name:STANDLEY, INNA KRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:INNA
Middle Name:KRISTINE
Last Name:STANDLEY
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 1:1414 SHORE DISTRICT DR APT 3106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-2100
Mailing Address - Country:US
Mailing Address - Phone:909-771-8599
Mailing Address - Fax:
Practice Address - Street 1:400 WETZEL RD
Practice Address - Street 2:UNIT A
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:512-256-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX394431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice