Healthcare Provider Details

I. General information

NPI: 1720912934
Provider Name (Legal Business Name): KRISTIN MARIE BURLEIGH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 BUCKTHORN RD
OAK HARBOR WA
98277-8801
US

IV. Provider business mailing address

1982 BUCKTHORN RD
OAK HARBOR WA
98277-8801
US

V. Phone/Fax

Practice location:
  • Phone: 636-578-9996
  • Fax:
Mailing address:
  • Phone: 636-578-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDEHL.HL.61206932
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: