Provider Demographics
NPI:1700568870
Name:KYRITSIS, CHRISTINE AZEVEDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:AZEVEDO
Last Name:KYRITSIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1325
Mailing Address - Country:US
Mailing Address - Phone:973-510-3540
Mailing Address - Fax:
Practice Address - Street 1:56 FERRY ST STE 5
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1833
Practice Address - Country:US
Practice Address - Phone:973-344-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02991800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist