Provider Demographics
NPI:1962699801
Name:YORK, KRISTIN H (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:H
Last Name:YORK
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 1:207 NORTH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3083
Mailing Address - Country:US
Mailing Address - Phone:765-743-3122
Mailing Address - Fax:765-838-0374
Practice Address - Street 1:207 NORTH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3083
Practice Address - Country:US
Practice Address - Phone:765-743-3122
Practice Address - Fax:765-838-0374
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011003A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice