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General NPI Number Information
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NPI Number | 1104501964
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Entity Type | Individual
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Provider Name | CHRISTIAN DALE TRIA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 8610 BARKER CYPRESS RD
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City | CYPRESS
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State | TX
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Zip | 77433-5336
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Country | US
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Telephone | 346-445-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 20902 FLORETTE LN
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City | SPRING
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State | TX
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Zip | 77388-4237
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Country | US
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Telephone | 832-466-6225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39539
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License Number State | TX
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