Provider Demographics
NPI:1306459151
Name:ANDERSON, KRISTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:ANDERSON
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 1:2535 E BIDWELL ST # 101
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6456
Mailing Address - Country:US
Mailing Address - Phone:916-204-5293
Mailing Address - Fax:
Practice Address - Street 1:8359 ELK GROVE FLORIN RD STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9298
Practice Address - Country:US
Practice Address - Phone:916-689-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice