Provider Demographics
NPI:1740639624
Name:NODING, KRISTINA ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:NODING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 N CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020
Mailing Address - Country:US
Mailing Address - Phone:715-294-3303
Mailing Address - Fax:
Practice Address - Street 1:215 N CASCADE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-5402
Practice Address - Country:US
Practice Address - Phone:715-294-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist