Provider Demographics
NPI:1316665136
Name:KRISTIN BROTHERS DDS INC
Entity type:Organization
Organization Name:KRISTIN BROTHERS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:BROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-809-3527
Mailing Address - Street 1:23451 MADISON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4736
Mailing Address - Country:US
Mailing Address - Phone:310-375-0001
Mailing Address - Fax:
Practice Address - Street 1:23451 MADISON ST STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4736
Practice Address - Country:US
Practice Address - Phone:310-375-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTIN BROTHERS DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty