Provider Demographics
NPI:1215165337
Name:HYNES, KRISTINE E (DDS)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:HYNES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:E
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 SUTTLE ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8276
Mailing Address - Country:US
Mailing Address - Phone:970-403-9120
Mailing Address - Fax:
Practice Address - Street 1:701 CAMINO DEL RIO STE 316
Practice Address - Street 2:AXIS ORAL HEALTH CLINIC
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5596
Practice Address - Country:US
Practice Address - Phone:970-335-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24653122300000X
CO0202314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist