# DR. KRISTEN RENEE CRAWFORD ELLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1811283450
- **Gender:** F
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2014031509 | MO | — |
| 122300000X | Dentist | 29356 | TX | Yes |
| 1223G0001X | General Practice Dentistry | 6244 | LA | — |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 01/10/2022

## 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 |