Healthcare Provider Details

I. General information

NPI: 1861587941
Provider Name (Legal Business Name): PATRICIA JO KRIBBS DDS MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 PLAZA PL SUITE 110
RALEIGH NC
27612-6346
US

IV. Provider business mailing address

2840 PLAZA PL SUITE 110
RALEIGH NC
27612-6346
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-8060
  • Fax: 919-787-8098
Mailing address:
  • Phone: 919-787-8060
  • Fax: 919-787-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: