Healthcare Provider Details

I. General information

NPI: 1730221581
Provider Name (Legal Business Name): KRISTINE CROY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 MYRTLE AVE
EUREKA CA
95501-1219
US

IV. Provider business mailing address

959 MYRTLE AVE
EUREKA CA
95501-1219
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-7078
  • Fax: 707-442-7298
Mailing address:
  • Phone: 707-442-7078
  • Fax: 707-442-7298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: