Provider Demographics
NPI:1942937644
Name:CHRISTOPHER CARLSTON DDS INC
Entity Type:Organization
Organization Name:CHRISTOPHER CARLSTON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-973-2279
Mailing Address - Street 1:675 CAMINO DE LOS MARES STE 501
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2837
Mailing Address - Country:US
Mailing Address - Phone:949-248-2525
Mailing Address - Fax:
Practice Address - Street 1:675 CAMINO DE LOS MARES STE 501
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2837
Practice Address - Country:US
Practice Address - Phone:949-248-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental