Provider Demographics
NPI:1215410949
Name:GOBLE, KRISTEN MACKENZIE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MACKENZIE
Last Name:GOBLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 MARY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1945
Mailing Address - Country:US
Mailing Address - Phone:734-649-6958
Mailing Address - Fax:
Practice Address - Street 1:1433 MARY DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1945
Practice Address - Country:US
Practice Address - Phone:734-649-6958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist