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General NPI Number Information
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NPI Number | 1407488075
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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 | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 440 CHESTNUT ST # 100
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4807
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Country | US
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Telephone | 715-421-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 3902 OAKWOOD HILLS PKWY
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City | EAU CLAIRE
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State | WI
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Zip | 54701-7780
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Country | US
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Telephone | 715-598-7473
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Fax |
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Authorized Official
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Title or Position | OPERATIONS SUPPORT MANAGER
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Name | TAMMY WEGNER
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Credential |
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Telephone | 715-598-7473
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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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