Healthcare Provider Details

I. General information

NPI: 1922276591
Provider Name (Legal Business Name): KRISTINA L. WILEY, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N LINCOLN ST STE A
DIXON CA
95620-2172
US

IV. Provider business mailing address

805 N. LINCOLN ST SUITE A
DIXON CA
95620
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-9248
  • Fax: 707-678-9274
Mailing address:
  • Phone: 707-678-9248
  • Fax: 707-678-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD41149
License Number StateCA

VIII. Authorized Official

Name: DR. KRISTINA LINDE WILEY
Title or Position: OWNER
Credential: D.D.S.
Phone: 707-678-9248