Provider Demographics
NPI:1336208537
Name:OVERBY, KRISTAN K (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:K
Last Name:OVERBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 STATION DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9777
Mailing Address - Country:US
Mailing Address - Phone:253-912-4433
Mailing Address - Fax:253-912-4426
Practice Address - Street 1:1100 STATION DR
Practice Address - Street 2:SUITE 221
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9777
Practice Address - Country:US
Practice Address - Phone:253-912-4433
Practice Address - Fax:253-912-4426
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA43881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice