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General NPI Number Information
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NPI Number | 1659738367
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Entity Type | Individual
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Provider Name | KRITIKA JO CARRAZANA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 675 PINE AVE
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-3373
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Country | US
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Telephone | 831-649-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 COPPER PEAK DR
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City | DUBLIN
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State | CA
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Zip | 94568-4901
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Country | US
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Telephone | 772-563-3540
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025523
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 61137
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2016014866
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 107451
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License Number State | CA
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