Healthcare Provider Details

I. General information

NPI: 1093306417
Provider Name (Legal Business Name): CRYSTAL MEASNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STUTTGART DENTAL CLINIC COMMAND UNIT 30401
APO AE
09107
US

IV. Provider business mailing address

STUTTGART DENTAL CLINIC COMMAND UNIT 30401
APO AE
09107
US

V. Phone/Fax

Practice location:
  • Phone: 801-650-8272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12116
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: