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General NPI Number Information
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NPI Number | 1639637986
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Entity Type | Individual
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Provider Name | KRISTY CHANELLE PLEASANT DDS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 69160 RAMON RD
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-9140
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Country | US
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Telephone | 615-674-9131
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Fax |
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Provider Business Mailing Address
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Address Line | 30620 PAULINE AVE
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-6266
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Country | US
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Telephone | 615-674-9131
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105243
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License Number State | CA
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