Provider Demographics
NPI:1922545979
Name:CHRYSTLE CU
Entity Type:Organization
Organization Name:CHRYSTLE CU
Other - Org Name:YOUNG DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRYSTLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-703-9378
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:650-532-3092
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:650-532-3092
Practice Address - Fax:650-343-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA572871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty