Provider Demographics
NPI:1538607205
Name:CHRISTUS VENTURES PLLC
Entity type:Organization
Organization Name:CHRISTUS VENTURES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-439-8901
Mailing Address - Street 1:428 S OLD BETSY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-1411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 REEVES RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3855
Practice Address - Country:US
Practice Address - Phone:940-627-8400
Practice Address - Fax:940-627-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty