Provider Demographics
NPI:1427267392
Name:HARRIS, KRISTINA L (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:FEKETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1729 EBERS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3503
Mailing Address - Country:US
Mailing Address - Phone:312-339-9461
Mailing Address - Fax:
Practice Address - Street 1:9862 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3873
Practice Address - Country:US
Practice Address - Phone:619-596-1600
Practice Address - Fax:619-596-1680
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261211223G0001X
CA578741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice