Provider Demographics
NPI:1336552546
Name:BROTHERS, KRISTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:BROTHERS
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 1:23451 MADISON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4736
Mailing Address - Country:US
Mailing Address - Phone:310-375-0001
Mailing Address - Fax:
Practice Address - Street 1:23451 MADISON ST STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4736
Practice Address - Country:US
Practice Address - Phone:310-375-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316531223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics