Crownridge Dental
Clinic/Center, Oral and Maxillofacial Surgery in San Antonio, TX. Organization (NPI-2).
NPI number1962028142
StatusActive
Last updated in NPPESJun 23, 2020
Details
- NPI
- 1962028142
- Entity type
- Organization (NPI-2)
- Legal business name
- Crownridge Dental
- Organization subpart
- No
- Enumeration date
- Jun 23, 2020
- Certification date
- Jun 23, 2020
- Last updated
- Jun 23, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QS0112X | Clinic/Center, Oral and Maxillofacial Surgery | – | – | Yes |
Practice location
6827 Camp Bullis Rd Ste 302San Antonio, TX 78256-1730
Phone 210-538-7500 · Fax 210-569-7750
Mailing address
6827 Camp Bullis Rd Ste 302San Antonio, TX 78256-1730
Authorized official
Christian Alexander Pham
Owner
2105387500
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