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NPI Code Detail

MEDICARE: KURRIE KRYSTAL STENNIS D.D.S.

MEDICARE: KURRIE KRYSTAL STENNIS D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDN014903GA
3122300000XDentistDN014903GA

General Provider Information

NPI Number : 1477809598
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURRIE KRYSTAL STENNIS D.D.S.
Provider Business Mailing Address
First Line : 2607 GILLIONVILLE RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-3003
Country : US
Telephone Number : 229-883-9001
Fax Number :
Provider Business Practice Location Address
First Line : 2607 GILLIONVILLE RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-3003
Country : US
Telephone Number : 229-883-9001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2012
Last Update Date : 12/08/2014

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