Provider Demographics
NPI:1700111440
Name:GORMAN, KRISTI TENNILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:TENNILLE
Last Name:GORMAN
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 1:703 SE FULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4276
Mailing Address - Country:US
Mailing Address - Phone:479-234-2089
Mailing Address - Fax:
Practice Address - Street 1:805 N 20TH PL
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3571
Practice Address - Country:US
Practice Address - Phone:479-234-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice