Basic Information
| Provider Information | |||||||||
| NPI: | 1104082106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIPROVSKA-GAVRILOVA | ||||||||
| FirstName: | HRISTINA | ||||||||
| MiddleName: | TODOROVA | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12920 W PARMER LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124107774 | ||||||||
| FaxNumber: | 8665117471 | ||||||||
| Practice Location | |||||||||
| Address1: | 12920 W PARMER LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124107774 | ||||||||
| FaxNumber: | 8665117471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 24310 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.