Provider Demographics
NPI:1831191188
Name:DARR, KRISTA SMITH (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:SMITH
Last Name:DARR
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 1:3002 H G MOSLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2948
Mailing Address - Country:US
Mailing Address - Phone:903-758-3191
Mailing Address - Fax:903-758-3194
Practice Address - Street 1:3002 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2948
Practice Address - Country:US
Practice Address - Phone:903-758-3191
Practice Address - Fax:903-758-3194
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008748801Medicaid