Individual
MR. KRISS L CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
1407 WEST 29TH ST, PUEBLO, CO 81008
(719) 546-0404
(719) 546-0408
Mailing address
1407 WEST 29TH ST, PUEBLO, CO 81008
(719) 546-0404
(719) 546-0408
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
3009
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61938742
—
CO
Enumeration date
01/29/2007
Last updated
07/08/2007
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