Provider Demographics
NPI:1447475819
Name:KRISTALLIS, TERRY (DMD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:KRISTALLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 17TH ST NW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-2601
Mailing Address - Country:US
Mailing Address - Phone:202-887-1909
Mailing Address - Fax:202-887-0417
Practice Address - Street 1:910 17TH ST NW
Practice Address - Street 2:SUITE 108
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2601
Practice Address - Country:US
Practice Address - Phone:202-887-1909
Practice Address - Fax:202-887-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10005591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice