Provider Demographics
NPI:1801357637
Name:CRDENTAL,PLLC
Entity Type:Organization
Organization Name:CRDENTAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-815-9633
Mailing Address - Street 1:631 E ROYAL LN APT 3003
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3571
Mailing Address - Country:US
Mailing Address - Phone:630-815-9633
Mailing Address - Fax:
Practice Address - Street 1:1107 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3827
Practice Address - Country:US
Practice Address - Phone:972-254-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental