Healthcare Provider Details

I. General information

NPI: 1124143128
Provider Name (Legal Business Name): KRISTIN M FOLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 S ALAFAYA TRL STE 200
ORLANDO FL
32828-8962
US

IV. Provider business mailing address

1201 N PENNSYLVANIA AVE
WINTER PARK FL
32789-2455
US

V. Phone/Fax

Practice location:
  • Phone: 407-482-1405
  • Fax:
Mailing address:
  • Phone: 610-310-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN18902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: