Provider Demographics
NPI:1124143128
Name:FOLEY, KRISTIN M (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:FOLEY
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 1:1201 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2455
Mailing Address - Country:US
Mailing Address - Phone:610-310-2582
Mailing Address - Fax:
Practice Address - Street 1:1549 S ALAFAYA TRL STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8962
Practice Address - Country:US
Practice Address - Phone:407-482-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN189021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program