Provider Demographics
NPI:1750765145
Name:WINCHESTER DENTAL ADMIN
Entity type:Organization
Organization Name:WINCHESTER DENTAL ADMIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-970-4000
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2797
Mailing Address - Country:US
Mailing Address - Phone:281-970-4000
Mailing Address - Fax:281-213-4105
Practice Address - Street 1:9447 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:281-970-4000
Practice Address - Fax:281-213-4105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINCHESTER DENTAL ADMIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty