Provider Demographics
NPI:1316155799
Name:DANIELAK, KRISTINA J (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:J
Last Name:DANIELAK
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 1:1515 HARDING HWY E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4522
Mailing Address - Country:US
Mailing Address - Phone:740-387-1466
Mailing Address - Fax:740-751-4472
Practice Address - Street 1:1344 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2136
Practice Address - Country:US
Practice Address - Phone:614-866-1234
Practice Address - Fax:614-866-0504
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH216471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice