Provider Demographics
NPI:1750679627
Name:HEINKEL, CHRYSALIS AUTRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRYSALIS
Middle Name:AUTRY
Last Name:HEINKEL
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 1:11021 OLD CORPUS CHRISTI HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-9363
Mailing Address - Country:US
Mailing Address - Phone:210-633-0057
Mailing Address - Fax:888-633-2279
Practice Address - Street 1:11021 OLD CORPUS CHRISTI HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-9363
Practice Address - Country:US
Practice Address - Phone:210-633-0057
Practice Address - Fax:888-633-2279
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice