Healthcare Provider Details

I. General information

NPI: 1558793356
Provider Name (Legal Business Name): CHRISTINA L KASPRZYCKI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 WATTS ST
JACKSON MI
49203-2182
US

IV. Provider business mailing address

137 WATTS ST
JACKSON MI
49203-2182
US

V. Phone/Fax

Practice location:
  • Phone: 517-740-7422
  • Fax:
Mailing address:
  • Phone: 517-740-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902016622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: