Healthcare Provider Details

I. General information

NPI: 1477809598
Provider Name (Legal Business Name): KURRIE KRYSTAL STENNIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 GILLIONVILLE RD
ALBANY GA
31707-3003
US

IV. Provider business mailing address

8115 S ARTESIAN AVE
CHICAGO IL
60652-2838
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-9001
  • Fax:
Mailing address:
  • Phone: 872-801-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014903
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029716
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN014903
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: