Provider Demographics
NPI:1750891487
Name:CRAIG CHLEBICKI, DDS AND CHRISTOPHER CHARLES, DDS
Entity type:Organization
Organization Name:CRAIG CHLEBICKI, DDS AND CHRISTOPHER CHARLES, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-634-3503
Mailing Address - Street 1:1140 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2223
Mailing Address - Country:US
Mailing Address - Phone:925-634-3503
Mailing Address - Fax:
Practice Address - Street 1:1140 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2223
Practice Address - Country:US
Practice Address - Phone:925-634-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty