Individual
KRISTI SOASH FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1780 OLD HIGHWAY 50 E, UNION, MO 63084-3397
(636) 582-8100
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2011030116
MO
1223G0001X
General Practice Dentistry
2901019894
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841438421
—
MO
Enumeration date
02/04/2009
Last updated
05/23/2016
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