Individual
ANN H KRISTOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
901 W 38TH ST STE 410, AUSTIN, TX 78705
(512) 992-1378
Mailing address
901 W 38TH ST STE 410, AUSTIN, TX 78705-1162
(512) 992-1378
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
11503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008355204
—
TX
01
—
43319YKZJ
MEDICARE
TX
Enumeration date
04/18/2007
Last updated
06/28/2018
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