Provider Demographics
NPI:1356425821
Name:NORMAN, KIRISTI (DDS)
Entity type:Individual
Prefix:
First Name:KIRISTI
Middle Name:
Last Name:NORMAN
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 1:2635 LEE RD STE C-4
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3356
Mailing Address - Country:US
Mailing Address - Phone:770-489-9141
Mailing Address - Fax:770-489-9138
Practice Address - Street 1:2635 LEE RD STE C-4
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3356
Practice Address - Country:US
Practice Address - Phone:770-489-9141
Practice Address - Fax:770-489-9138
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
100618OtherAVESIS
288357OtherCIGNA
1873153OtherUNITED CONCORIDIA INS
7404776OtherAETNA
9182350OtherDORAL USA
GA141895700AMedicaid