Individual
DR. KRYSTYN MARIE DISHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
1007 ASHLAWN DR, SOUTHLAKE, TX 76092-1716
(214) 543-1620
Mailing address
1007 ASHLAWN DR, SOUTHLAKE, TX 76092-1716
(214) 543-1620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22861
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1479404-01
—
TX
05
—
1479404-03
—
TX
05
—
1479404-04
—
TX
05
—
1479404-05
—
TX
05
—
1479404-06
—
TX
05
—
1479404-07
—
TX
05
—
1479404-08
—
TX
05
—
1479404-09
—
TX
05
—
1479404-10
—
TX
05
—
1479404-11
—
TX
05
—
1479404-12
—
TX
05
—
1803512-01
—
TX
05
—
1803512-02
—
TX
Enumeration date
04/02/2007
Last updated
01/25/2024
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