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NPI Code Detail

MEDICARE: DR. KRISTIN MARIE SHINNICK D.M.D

MEDICARE: DR. KRISTIN MARIE SHINNICK D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry13722FL

General Provider Information

NPI Number : 1124530191
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN MARIE SHINNICK D.M.D
Provider Business Mailing Address
First Line : 208 HOSPITAL DR NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5068
Country : US
Telephone Number : 850-243-8124
Fax Number :
Provider Business Practice Location Address
First Line : 208 HOSPITAL DR NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5068
Country : US
Telephone Number : 850-243-8124
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2017
Last Update Date : 10/31/2017

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Directions to “ DR. KRISTIN MARIE SHINNICK D.M.D” Practice Location

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