Healthcare Provider Details

I. General information

NPI: 1154464576
Provider Name (Legal Business Name): KRISTINE SPRING WEST DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE SPRING WEST DDS, MS

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13109 SCHAVEY RD STE 1
DEWITT MI
48820-9015
US

IV. Provider business mailing address

13109 SCHAVEY RD STE 1
DEWITT MI
48820-9015
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-3001
  • Fax:
Mailing address:
  • Phone: 517-507-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number056161-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number015524
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901016440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: