Provider Demographics
NPI:1477654119
Name:TIM A CRIST DDS PA
Entity Type:Organization
Organization Name:TIM A CRIST DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-873-0555
Mailing Address - Street 1:420 WEST GREENS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4500
Mailing Address - Country:US
Mailing Address - Phone:281-873-6942
Mailing Address - Fax:281-872-0555
Practice Address - Street 1:420 WEST GREENS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4500
Practice Address - Country:US
Practice Address - Phone:281-873-6942
Practice Address - Fax:281-872-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX D 12277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty