Provider Demographics
NPI:1073904413
Name:ALD CYPRESS PLLC
Entity Type:Organization
Organization Name:ALD CYPRESS PLLC
Other - Org Name:ACTIVE LIFE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-970-4000
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2797
Mailing Address - Country:US
Mailing Address - Phone:281-970-4000
Mailing Address - Fax:281-213-4105
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2797
Practice Address - Country:US
Practice Address - Phone:281-970-4000
Practice Address - Fax:281-213-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19333261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental