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General NPI Number Information
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NPI Number | 1336839430
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Entity Type | Individual
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Provider Name | KRISTA CAMILLE CHARLES RDH
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 3510 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77002-9567
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Country | US
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Telephone | 346-815-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 642 TERRELL DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-5144
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Country | US
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Telephone | 318-564-8187
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 25340
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License Number State | TX
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