Basic Information
| Provider Information | |||||||||
| NPI: | 1649511585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASSTEDT | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 JUNIPER ST NE APT 1243 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303081696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154503384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4280 LAVISTA RD STE C117 | ||||||||
| Address2: | |||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300845315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786884811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | D14322 | MN | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | DN015992 | GA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.