Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | D11640 | TX |
N | 1223X0400X | Orthodontists | D11640 | TX |
NPI | 1013928233 |
---|---|
Provider Name | Michael A Crist |
First Address | Houston, TX 77069-2650 |
Second Address | Houston, TX 77069-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |