Provider Demographics
NPI:1043915150
Name:TIU, CHRISELLE BARITUA
Entity type:Individual
Prefix:
First Name:CHRISELLE
Middle Name:BARITUA
Last Name:TIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 PINEVILLE MATTHEWS RD APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4735
Mailing Address - Country:US
Mailing Address - Phone:386-546-6810
Mailing Address - Fax:
Practice Address - Street 1:582 KANNAPOLIS PKWY
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28027-8215
Practice Address - Country:US
Practice Address - Phone:704-273-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13752122300000X
SC10751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist