Healthcare Provider Details

I. General information

NPI: 1194822106
Provider Name (Legal Business Name): CHRISTIAN LEE NINO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 KIRBY DR
HOUSTON TX
77005-2408
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 713-352-3509
  • Fax:
Mailing address:
  • Phone: 210-928-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: