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General NPI Number Information
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NPI Number | 1710962626
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Entity Type | Individual
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Provider Name | KRISTA COLLEEN IRWIN DMD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | CAMP CASEY DC 618TH DC (AS) UNIT # 15658
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City | APO
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State | AP
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Zip | 96224-5658
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Country | KR
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Telephone | 01031356980
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WARREN ST APT 206
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3621
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Country | US
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Telephone | 617-610-6980
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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 | 21136
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License Number State | MA
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