Kristi Archer, CDA
Individual provider Active NPI Dental Assistant · Centerville, OH
NPI 1306235494 · NPPES record last updated Jan 13, 2015
Key facts
- NPI
- 1306235494
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Assistant 126800000X
- License
- 101073 (OH)
- Practice address
- 7058 Corporate Way
Suite 3
Centerville, OH 45459-4295 - Phone
- (937) 586-7729
- NPI assigned
- Jan 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101073 | OH | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 101073 | OH | Yes |
Addresses
Primary practice location
7058 Corporate Way
Suite 3
Centerville, OH 45459-4295
Mailing address
1245 S Maple Ave
Fairborn, OH 45324-3647
Other providers in Centerville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.