Dishaw, Krystyn Marie

Dishaw, Krystyn Marie is an individual health care provider with primary practice located at 1007 Ashlawn Dr , Southlake TX 76092-1716. She recently has 2 registered licenses in different health care specialties including Dental Providers / Orthodontics and Dentofacial Orthopedics, Dental Providers / Dentist. Dental Providers / Orthodontics and Dentofacial Orthopedics is her primary health care specialty. Dishaw, Krystyn Marie can be contacted via phone (214) 543-1620.

Contact Information

Primary practice address
1007 Ashlawn Dr Southlake TX 76092-1716
Phone: (214) 543-1620
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 22861 Texas
Dental Providers / Dentist 122300000X 22861 Texas

Profile Details

NPI number 1144341793
LBN Legal business name Dishaw, Krystyn Marie
Credentials DMD, MS
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 2nd, 2007
Last updated Jan 25th, 2024 - about 10 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144341793 NPPES
Texas MEDICAID 1479404-03
Texas MEDICAID 1479404-09
Texas MEDICAID 1479404-10
Texas MEDICAID 1479404-04
Texas MEDICAID 1479404-05
Texas MEDICAID 1479404-08
Texas MEDICAID 1479404-12
Texas MEDICAID 1803512-01
Texas MEDICAID 1479404-01
Texas MEDICAID 1479404-06
Texas MEDICAID 1479404-07
Texas MEDICAID 1479404-11
Texas MEDICAID 1803512-02

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