Provider Demographics
NPI:1902973696
Name:KRISTAN K OVERBY DDS PS
Entity Type:Organization
Organization Name:KRISTAN K OVERBY DDS PS
Other - Org Name:DUPONT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUEZANN
Authorized Official - Middle Name:LASSEN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-912-4443
Mailing Address - Street 1:1100 STATION DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9777
Mailing Address - Country:US
Mailing Address - Phone:253-912-4443
Mailing Address - Fax:253-912-4426
Practice Address - Street 1:1100 STATION DR
Practice Address - Street 2:SUITE 221
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9777
Practice Address - Country:US
Practice Address - Phone:253-912-4443
Practice Address - Fax:253-912-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty