Provider Demographics
NPI:1306144340
Name:GEORGE, KRISTEN EVE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:EVE
Last Name:GEORGE
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 1:12903 REHL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4711
Mailing Address - Country:US
Mailing Address - Phone:502-262-9258
Mailing Address - Fax:
Practice Address - Street 1:303 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1344
Practice Address - Country:US
Practice Address - Phone:502-262-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY87831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics