Provider Demographics
NPI:1184008567
Name:ALDTOWNELAKE
Entity Type:Organization
Organization Name:ALDTOWNELAKE
Other - Org Name:ALDTOWNELAKE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
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 #220
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:281-970-4000
Mailing Address - Fax:
Practice Address - Street 1:9740 BARKER CYPRESS
Practice Address - Street 2:SUITE 113
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:281-970-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRIS BLUME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty