Provider Demographics
NPI:1669190831
Name:CLYMER, KRISSI
Entity type:Individual
Prefix:
First Name:KRISSI
Middle Name:
Last Name:CLYMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PUHI LN
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4992
Mailing Address - Country:US
Mailing Address - Phone:303-856-5385
Mailing Address - Fax:
Practice Address - Street 1:1 KANEOHE BAY DRIVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:314-727-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025609124Q00000X
HI2245124Q00000X
OH31.015642124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist