Provider Demographics
NPI:1649511585
Name:HASSTEDT, KRISTOPHER LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:LEE
Last Name:HASSTEDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1911 MOBLEY WAY APT 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2272
Mailing Address - Country:US
Mailing Address - Phone:515-450-3384
Mailing Address - Fax:
Practice Address - Street 1:111 FOX RD STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-9000
Practice Address - Country:US
Practice Address - Phone:865-381-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND143221223S0112X
GADN0159921223S0112X
TN119991223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery