Provider Demographics
NPI:1366059123
Name:COLUMNA, MARI KRIS (RDA)
Entity type:Individual
Prefix:MRS
First Name:MARI KRIS
Middle Name:
Last Name:COLUMNA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 BLUEGRASS WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1830
Mailing Address - Country:US
Mailing Address - Phone:858-265-8941
Mailing Address - Fax:
Practice Address - Street 1:5209 BLUEGRASS WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-1830
Practice Address - Country:US
Practice Address - Phone:858-265-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67515126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant