Provider Demographics
NPI:1023437928
Name:DISLA, CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:DISLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 N INTERSTATE 35
Mailing Address - Street 2:SUITE 1320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1019
Mailing Address - Country:US
Mailing Address - Phone:512-990-8300
Mailing Address - Fax:
Practice Address - Street 1:12901 N INTERSTATE 35
Practice Address - Street 2:1320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1019
Practice Address - Country:US
Practice Address - Phone:512-990-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist