Provider Demographics
NPI:1396960571
Name:DOBERENZ, KRISTI (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:
Last Name:DOBERENZ
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 1:8 CAMINO ENCINAS
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3350
Mailing Address - Country:US
Mailing Address - Phone:925-254-3725
Mailing Address - Fax:925-254-3701
Practice Address - Street 1:8 CAMINO ENCINAS
Practice Address - Street 2:SUITE 110
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3350
Practice Address - Country:US
Practice Address - Phone:925-254-3725
Practice Address - Fax:925-254-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist