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General NPI Number Information
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NPI Number | 1760873343
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Entity Type | Individual
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Provider Name | CRYSTAL NICOLE TSCHANTZ DDS
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Gender | Female
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 4030 LAWRENCEVILLE HWY NW
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City | LILBURN
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State | GA
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Zip | 30047-3011
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Country | US
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Telephone | 678-392-2385
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Fax |
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Provider Business Mailing Address
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Address Line | 231 SUNSET HILLS DRIVE
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City | NORCROSS
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State | GA
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Zip | 30071
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Country | US
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Telephone | 706-619-6305
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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 | DN014926
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014926
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License Number State | GA
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