Provider Demographics
NPI:1689002164
Name:CYPRESS CREEK DENTAL PLLC
Entity Type:Organization
Organization Name:CYPRESS CREEK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABBIR
Authorized Official - Middle Name:YAHYA
Authorized Official - Last Name:BOXWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-639-4831
Mailing Address - Street 1:27118 WINDY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7570
Mailing Address - Country:US
Mailing Address - Phone:281-639-4831
Mailing Address - Fax:
Practice Address - Street 1:27118 WINDY GROVE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7570
Practice Address - Country:US
Practice Address - Phone:281-639-4831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty