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Individual
DR. KRISTEN RENEE CRAWFORD ELLIS
Active
Individual
DR. KRISTEN RENEE CRAWFORD ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2014031509
MO
122300000X
Dentist
Primary
29356
TX
1223G0001X
General Practice Dentistry
6244
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014031509
MISSOURI DENTAL LICENSE
MO
01
—
29356
TEXAS DENTAL LICENSE
TX
01
—
6244
BOARD OF DENTISTRY LICENSE
LA
Enumeration date
06/22/2011
Last updated
01/10/2022
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