Provider Demographics
NPI:1780770149
Name:WITHROW-NATERNICOLA, KRISTINA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNN
Last Name:WITHROW-NATERNICOLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:NATERNICOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7016 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7811
Mailing Address - Country:US
Mailing Address - Phone:304-777-6444
Mailing Address - Fax:
Practice Address - Street 1:304 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1343
Practice Address - Country:US
Practice Address - Phone:304-765-2522
Practice Address - Fax:304-765-2622
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist