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General NPI Number Information
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NPI Number | 1104205285
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Entity Type | Organization
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Legal Business Name | KRISTO LTD
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1460 10TH AVE
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City | BALDWIN
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State | WI
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Zip | 54002-9342
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Country | US
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Telephone | 715-684-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 10TH AVE PO BOX 516
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City | BALDWIN
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State | WI
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Zip | 54002-9342
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Country | US
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Telephone | 715-684-5858
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN KRISTO
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Credential |
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Telephone | 715-835-5182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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