Provider Demographics
NPI:1700038635
Name:CU, CHRYSTLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTLE
Middle Name:
Last Name:CU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 2ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3841
Mailing Address - Country:US
Mailing Address - Phone:650-343-3836
Mailing Address - Fax:650-343-0528
Practice Address - Street 1:126 2ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3841
Practice Address - Country:US
Practice Address - Phone:650-343-3836
Practice Address - Fax:650-343-0528
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist