Individual
DR. AMANDA RAE KRONQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1906 N BROADWAY, SANTA ANA, CA 92706-2610
(714) 547-6671
Mailing address
1906 N BROADWAY, SANTA ANA, CA 92706-2610
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
64750
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
64750
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64750
DENTAL BOARD OF CALIFORNIA DENTAL LICENSE
CA
Enumeration date
09/15/2015
Last updated
08/11/2022
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