Healthcare Provider Details

I. General information

NPI: 1619402948
Provider Name (Legal Business Name): KRYSTAL KAZEMBA DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ZIMMERMAN TRL STE 1
BILLINGS MT
59102
US

IV. Provider business mailing address

1601 ZIMMERMAN TRL STE 1
BILLINGS MT
59102-7654
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-3303
  • Fax:
Mailing address:
  • Phone: 406-248-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN-DEN-LIC-21520
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: