Provider Demographics
NPI:1770610214
Name:DAHLBERG, KRISTI (SFA)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:DAHLBERG
Suffix:
Gender:F
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5017
Mailing Address - Country:US
Mailing Address - Phone:423-877-3005
Mailing Address - Fax:423-875-8338
Practice Address - Street 1:105 FAIR ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-5017
Practice Address - Country:US
Practice Address - Phone:423-877-3005
Practice Address - Fax:423-875-8338
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist