Provider Demographics
NPI:1962723320
Name:SLACHTA, KRISTY LYNN (DMD)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:SLACHTA
Suffix:
Gender:F
Credentials:DMD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 6, SUITE 108
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-2006
Mailing Address - Fax:
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BUILDING 6, SUITE 108
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024779001223P0221X
PADS0381331223P0221X
NJ22DI024779011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry