Provider Demographics
NPI:1811013584
Name:CORPUS CHRISTI GENERAL & IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:CORPUS CHRISTI GENERAL & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-857-5494
Mailing Address - Street 1:3420 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1720
Mailing Address - Country:US
Mailing Address - Phone:361-857-5494
Mailing Address - Fax:361-852-1984
Practice Address - Street 1:3420 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1720
Practice Address - Country:US
Practice Address - Phone:361-857-5494
Practice Address - Fax:361-852-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty