Provider Demographics
NPI:1578086948
Name:CRONIN, KAITLIN FAITH (DDS)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:FAITH
Last Name:CRONIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAITLIN
Other - Middle Name:FAITH
Other - Last Name:VICARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3225 OAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5627
Mailing Address - Country:US
Mailing Address - Phone:402-972-4400
Mailing Address - Fax:
Practice Address - Street 1:3225 OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5627
Practice Address - Country:US
Practice Address - Phone:402-972-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice