Individual
KRISTINE DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2510 S TEXAS AVE, BRYAN, TX 77802-2329
(979) 704-5245
Mailing address
125 SW MILITARY DR, SAN ANTONIO, TX 78221-1650
(210) 922-3483
(210) 927-4975
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
25239
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209944216
—
TX
05
—
379870403
—
TX
Enumeration date
07/25/2007
Last updated
09/26/2020
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