Provider Demographics
NPI:1497133284
Name:WEST BRANCH FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:WEST BRANCH FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHRYSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-345-7750
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-0515
Mailing Address - Country:US
Mailing Address - Phone:989-345-7750
Mailing Address - Fax:
Practice Address - Street 1:3561 W M 76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9607
Practice Address - Country:US
Practice Address - Phone:989-345-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010163111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty