Provider Demographics
NPI:1790209484
Name:CASON, CHRISTOPHER RYLAN (DMD, OMFS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RYLAN
Last Name:CASON
Suffix:
Gender:M
Credentials:DMD, OMFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6611
Mailing Address - Country:US
Mailing Address - Phone:781-771-2719
Mailing Address - Fax:
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333091223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice