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General NPI Number Information
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NPI Number | 1679744239
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Entity Type | Organization
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Legal Business Name | JONATHAN N. KRISTIANTO, DDS INC.
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 1556 N MAIN ST
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City | SALINAS
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State | CA
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Zip | 93906-5101
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Country | US
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Telephone | 831-444-0882
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Fax |
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Provider Business Mailing Address
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Address Line | 1556 N MAIN ST
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City | SALINAS
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State | CA
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Zip | 93906-5101
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Country | US
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Telephone | 831-444-0882
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TINA KRISTIANTO
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Credential |
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Telephone | 831-444-0882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | CA37441
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License Number State | CA
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