Provider Demographics
NPI:1982788774
Name:WILEY, KRISTINA LINDE (DDS)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LINDE
Last Name:WILEY
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 1:805 N LINCOLN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2172
Mailing Address - Country:US
Mailing Address - Phone:707-678-9248
Mailing Address - Fax:707-678-9274
Practice Address - Street 1:805 N LINCOLN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2172
Practice Address - Country:US
Practice Address - Phone:707-678-9248
Practice Address - Fax:707-678-9274
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice