Provider Demographics
NPI:1497316418
Name:SELF, KRISTEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:SELF
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 1:1058 FM 306 STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7551
Mailing Address - Country:US
Mailing Address - Phone:830-730-4143
Mailing Address - Fax:
Practice Address - Street 1:1058 FM 306 STE 104
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7551
Practice Address - Country:US
Practice Address - Phone:830-730-4143
Practice Address - Fax:830-730-4403
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty