Provider Demographics
NPI:1902467921
Name:CARDELLES, KRISTINA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:M
Last Name:CARDELLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6725
Mailing Address - Country:US
Mailing Address - Phone:305-206-7783
Mailing Address - Fax:
Practice Address - Street 1:383 W 34TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4309
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist