MEDICARE: MS. KATHY ROBIN KRISINSKI DENTAL ASSISTANT II

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	126800000X	Dental Assistant		OR

General Provider Information

NPI Number	:	1982824967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ROBIN KRISINSKI DENTAL ASSISTANT II

Provider Business Mailing Address
First Line	:	PMB 906
Second Line	:	16420 SE MCGILLIURAY
City	:	VANCOUVER
State	:	WA
Zip	:	98683
Country	:	US
Telephone Number	:	360-513-5247
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100 KAISER DENTAL STAFFING ON CALL
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	360-513-5247
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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