Provider Demographics
NPI:1629889928
Name:HALL, KRISTYN (RDHAP)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-8050
Mailing Address - Country:US
Mailing Address - Phone:530-514-2990
Mailing Address - Fax:
Practice Address - Street 1:17100 N GRANITE DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-8050
Practice Address - Country:US
Practice Address - Phone:530-514-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1129124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist