Provider Demographics
NPI:1346629052
Name:PARTIN-AGARWAL, KRISTIE LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:LYNN
Last Name:PARTIN-AGARWAL
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 1:10632 GRETNA GREEN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1832
Mailing Address - Country:US
Mailing Address - Phone:360-292-5887
Mailing Address - Fax:
Practice Address - Street 1:165TH MEDICAL GROUP
Practice Address - Street 2:358 OELSCHIG DR
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31408
Practice Address - Country:US
Practice Address - Phone:912-966-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9379316-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist