Provider Demographics
NPI:1588455786
Name:CHILDERS, KRISTOFFER (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFFER
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8714
Mailing Address - Country:US
Mailing Address - Phone:309-258-4526
Mailing Address - Fax:
Practice Address - Street 1:6632 W 10TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9734
Practice Address - Country:US
Practice Address - Phone:970-353-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00206291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist