Provider Demographics
NPI:1396099891
Name:LOW, KIRSTIN MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MICHELLE
Last Name:LOW
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 1:334 HEARD AVE, BLDG 556
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857
Mailing Address - Country:US
Mailing Address - Phone:808-655-8777
Mailing Address - Fax:
Practice Address - Street 1:334 HEARD AVE, BLDG 556
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-655-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61627122300000X
PADS0393851223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice