Kristina Marie Bath, DMD
Individual provider Active NPI Dentist · Whitefish Bay, WI
NPI 1093129165 · NPPES record last updated Jun 17, 2014
Key facts
- NPI
- 1093129165
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7261-15 (WI)
- Practice address
- 105 W Silver Spring Dr
Whitefish Bay, WI 53217-4708 - Phone
- (414) 964-0680
- NPI assigned
- Jun 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150615000111 | WI | Order and Referring Only - Other (Non-Physician) | 2163733445 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7261-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edp of Wisconsin, SC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7261-15 | WI | Yes |
Addresses
Primary practice location
105 W Silver Spring Dr
Whitefish Bay, WI 53217-4708
Mailing address
105 W Silver Spring Dr
Whitefish Bay, WI 53217-4708
Phone (414) 964-0680
Other providers in Whitefish Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.