Healthcare Provider Details

I. General information

NPI: 1396194510
Provider Name (Legal Business Name): CRISTINA M RIBEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE. DC#3
FT. MEADE MD
20755
US

IV. Provider business mailing address

8476 SIMOND ST SUITE 5700
FORT GEORGE G. MEADE MD
20755
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8955
  • Fax:
Mailing address:
  • Phone: 301-677-6122
  • Fax: 301-677-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6567
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: