Provider Demographics
NPI:1487799508
Name:RALL, KRISTY LEE (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEE
Last Name:RALL
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27021 MARISCAL LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4438
Mailing Address - Country:US
Mailing Address - Phone:949-470-9382
Mailing Address - Fax:949-470-9382
Practice Address - Street 1:27021 MARISCAL LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4438
Practice Address - Country:US
Practice Address - Phone:949-470-9382
Practice Address - Fax:949-470-9382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 73124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist