Provider Demographics
NPI:1588997217
Name:OLSEN-SMITH, KRISTIN ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANN
Last Name:OLSEN-SMITH
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 1:1 WALLIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5416
Mailing Address - Country:US
Mailing Address - Phone:781-862-1338
Mailing Address - Fax:781-862-3544
Practice Address - Street 1:1 WALLIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5416
Practice Address - Country:US
Practice Address - Phone:781-862-1338
Practice Address - Fax:781-862-3544
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice