Provider Demographics
NPI:1437251659
Name:CHRISTI DENTAL CENTER PA
Entity Type:Organization
Organization Name:CHRISTI DENTAL CENTER PA
Other - Org Name:WILLIAM T COOPER DDS HECTOR T GARCIA DDS COLEMAN NOCKOLDS DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-387-1531
Mailing Address - Street 1:109 E AVE J
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380
Mailing Address - Country:US
Mailing Address - Phone:361-387-1531
Mailing Address - Fax:361-767-8802
Practice Address - Street 1:109 E AVE J
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380
Practice Address - Country:US
Practice Address - Phone:361-387-1531
Practice Address - Fax:361-767-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124241223G0001X
TX144001223G0001X
TX88201223G0001X
TX161981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0610501OtherCHIP