Provider Demographics
NPI:1104082106
Name:KIPROVSKA-GAVRILOVA, HRISTINA TODOROVA (DDS)
Entity type:Individual
Prefix:
First Name:HRISTINA
Middle Name:TODOROVA
Last Name:KIPROVSKA-GAVRILOVA
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 1:12920 W PARMER LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7634
Mailing Address - Country:US
Mailing Address - Phone:512-410-7774
Mailing Address - Fax:866-511-7471
Practice Address - Street 1:12920 W PARMER LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7634
Practice Address - Country:US
Practice Address - Phone:512-410-7774
Practice Address - Fax:866-511-7471
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice