MEDICARE: DR. KRYSTELLE NICOLE ANAYA DDS

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
1	1223G0001X	General Practice Dentistry	28337	TX

General Provider Information

NPI Number	:	1790031516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTELLE NICOLE ANAYA DDS

Provider Business Mailing Address
First Line	:	3110 TRAWOOD DR
Second Line	:	STE D
City	:	EL PASO
State	:	TX
Zip	:	79936-4394
Country	:	US
Telephone Number	:	915-855-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 TRAWOOD DR
Second Line	:	STE D
City	:	EL PASO
State	:	TX
Zip	:	79936-4394
Country	:	US
Telephone Number	:	915-855-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	11/26/2012

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