Provider Demographics
NPI:1487390225
Name:SPAULDING, KRISTINA ANNE (LD)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:ANNE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-4511
Mailing Address - Country:US
Mailing Address - Phone:207-307-1432
Mailing Address - Fax:
Practice Address - Street 1:753 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3633
Practice Address - Country:US
Practice Address - Phone:207-573-4242
Practice Address - Fax:207-573-4233
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDTR5537122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist