Provider Demographics
NPI:1144877572
Name:MILLENDER, KRISTEN CAMILLE (DDS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CAMILLE
Last Name:MILLENDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 ORION CIR UNIT 379
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-3113
Mailing Address - Country:US
Mailing Address - Phone:305-713-7796
Mailing Address - Fax:
Practice Address - Street 1:3320 SAINT LUKES LN
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5836
Practice Address - Country:US
Practice Address - Phone:305-713-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist