Provider Demographics
NPI:1588078398
Name:STREITZ, KRISTINE VASQUEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:VASQUEZ
Last Name:STREITZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:B
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:16361 S PEERLESS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-9050
Mailing Address - Country:US
Mailing Address - Phone:407-760-1124
Mailing Address - Fax:
Practice Address - Street 1:13621 S ROUTE 59 UNIT 103
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-9701
Practice Address - Country:US
Practice Address - Phone:815-673-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL0190310341223G0001X
FLDN 211181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program