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NPI Code Detail

MEDICARE: DR. KRISTINE MYCROFT DMD

MEDICARE: DR. KRISTINE MYCROFT DMD
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
11223G0001XGeneral Practice DentistryDN015667GA

General Provider Information

NPI Number : 1972097541
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTINE MYCROFT DMD
Provider Business Mailing Address
First Line : 1126 HUTCH LN
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2246
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2175 NORTH RD
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2630
Country : US
Telephone Number : 770-284-9171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 09/10/2023

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