Provider Demographics
NPI:1326384421
Name:CRAIG CHLEBICKI, DDS AND CHRISTOPHER CHARLES, DDS
Entity Type:Organization
Organization Name:CRAIG CHLEBICKI, DDS AND CHRISTOPHER CHARLES, DDS
Other - Org Name:BRENTCOURT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-634-3503
Mailing Address - Street 1:1140 2ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2296
Mailing Address - Country:US
Mailing Address - Phone:925-634-3503
Mailing Address - Fax:
Practice Address - Street 1:1140 2ND ST
Practice Address - Street 2:STE A
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2296
Practice Address - Country:US
Practice Address - Phone:925-634-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty