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General NPI Number Information
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NPI Number | 1457471484
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Entity Type | Individual
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Provider Name | KRISTINA MARIE DENNINGTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 630 N KIMBALL AVENUE STE #100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9255
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Country | US
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Telephone | 817-421-8777
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Fax | 817-421-4388
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Provider Business Mailing Address
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Address Line | 4323 SODA RIDGE RD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9255
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Country | US
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Telephone | 469-371-9075
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M7904
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License Number State | TX
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