Provider Demographics
NPI:1336299049
Name:C MICHAEL ALTMAN DDS PC
Entity Type:Organization
Organization Name:C MICHAEL ALTMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-836-6767
Mailing Address - Street 1:1306 SOUTH BLUE BELL ROAD
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833
Mailing Address - Country:US
Mailing Address - Phone:979-836-6767
Mailing Address - Fax:979-836-5604
Practice Address - Street 1:1306 SOUTH BLUE BELL ROAD
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833
Practice Address - Country:US
Practice Address - Phone:979-836-6767
Practice Address - Fax:979-836-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172621223G0001X
TX169151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare UPIN