Provider Demographics
NPI:1992898456
Name:HOWARD, KRISY DAWN (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISY
Middle Name:DAWN
Last Name:HOWARD
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 1:122 STONE TRACE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-7500
Mailing Address - Country:US
Mailing Address - Phone:859-497-4444
Mailing Address - Fax:859-497-4446
Practice Address - Street 1:122 STONE TRACE DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7500
Practice Address - Country:US
Practice Address - Phone:859-497-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7943122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7943OtherSTATE LICENSE #
KYBC8327757OtherDEA #
KY7943OtherSTATE LICENSE #
KY45004314Medicaid
KY60003902Medicaid