Healthcare Provider Details

I. General information

NPI: 1619600020
Provider Name (Legal Business Name): DANIELLE KRISTAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 AVENUE U 2ND FLOOR
BROOKLYN NY
11223
US

IV. Provider business mailing address

20 OAK DR
ROSLYN NY
11576-2324
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13331
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: