Provider Demographics
NPI:1902642838
Name:RENFROW, KRISTIN MOORE (DMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MOORE
Last Name:RENFROW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BYHALIA RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1319
Mailing Address - Country:US
Mailing Address - Phone:662-429-5239
Mailing Address - Fax:662-449-0758
Practice Address - Street 1:460 BYHALIA RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1319
Practice Address - Country:US
Practice Address - Phone:662-429-5239
Practice Address - Fax:662-449-0758
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4456-24122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist