Provider Demographics
NPI:1982876918
Name:CRDENTIA CORPORATION
Entity Type:Organization
Organization Name:CRDENTIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRVP AND CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNBULL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-677-0400
Mailing Address - Street 1:1964 HOWELL BRANCH RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1042
Mailing Address - Country:US
Mailing Address - Phone:407-677-0400
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:407-677-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care