Provider Demographics
NPI:1164631131
Name:MAU, KRISTIN
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:MAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-8774
Mailing Address - Country:US
Mailing Address - Phone:517-645-9980
Mailing Address - Fax:517-645-9981
Practice Address - Street 1:400 S NELSON ST
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-8774
Practice Address - Country:US
Practice Address - Phone:517-645-9980
Practice Address - Fax:517-645-9981
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice