Provider Demographics
NPI:1396568515
Name:LIPORTO, KRISTEN A (RDH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:LIPORTO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 AGNES LN
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1502
Mailing Address - Country:US
Mailing Address - Phone:978-578-6476
Mailing Address - Fax:
Practice Address - Street 1:76 AGNES LN
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1502
Practice Address - Country:US
Practice Address - Phone:508-237-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH13909124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist