Kristine Donnelly, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

25239 Issued in TX

Practice address

2510 S Texas Ave
Bryan, TX 77802-2329

Phone

(979) 704-5245

NPI assigned

Jul 25, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bryan Pediatric Dentistry

  • Pediatric Dentistry
  • Bryan, TX
  • NPI 1891219499
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601078400000",
    "number": "1104016344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 SW MILITARY DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782211650",
            "telephone_number": "210-922-3483",
            "fax_number": "210-927-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 S TEXAS AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022329",
            "telephone_number": "979-704-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "KRISTINE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-25",
        "last_updated": "2020-09-26",
        "certification_date": "2020-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "25239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209944216",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379870403",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Matthew Jason Doles, ATC, LAT
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• David Doss
• William Lafayette Doss, M.D.
• Dr. Latino Family Clinic PLLC
• Alexya Jayde Drummond, LMSW

• Pediatric Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.