Provider Demographics
NPI:1285646190
Name:MASTROS, KRISTIN LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEIGH
Last Name:MASTROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 OLD OYSTER POINT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7177
Mailing Address - Country:US
Mailing Address - Phone:757-249-5128
Mailing Address - Fax:757-249-0875
Practice Address - Street 1:41 OLD OYSTER POINT RD
Practice Address - Street 2:SUITE H
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7177
Practice Address - Country:US
Practice Address - Phone:757-249-5128
Practice Address - Fax:757-249-0875
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist