Healthcare Provider Details

I. General information

NPI: 1023703253
Provider Name (Legal Business Name): CHRISTINA MARIE KUMAR RDA, CDA, RDH, MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 AVERY RANCH BLVD UNIT 1801
AUSTIN TX
78717-4013
US

IV. Provider business mailing address

14100 AVERY RANCH BLVD UNIT 1801
AUSTIN TX
78717-4013
US

V. Phone/Fax

Practice location:
  • Phone: 234-232-0525
  • Fax:
Mailing address:
  • Phone: 234-232-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number118990
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26252
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: