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General NPI Number Information
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NPI Number | 1477654119
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Entity Type | Organization
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Legal Business Name | TIM A CRIST DDS PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 WEST GREENS RD
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City | HOUSTON
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State | TX
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Zip | 77067-4500
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Country | US
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Telephone | 281-873-6942
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Fax | 281-872-0555
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Provider Business Mailing Address
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Address Line | 420 WEST GREENS RD
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City | HOUSTON
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State | TX
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Zip | 77067-4500
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Country | US
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Telephone | 281-873-6942
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Fax | 281-872-0555
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. TIMOTHY ALAN CRIST
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Credential | DDS
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Telephone | 281-873-0555
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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 | TX D 12277
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License Number State | TX
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