Provider Demographics
NPI:1174332886
Name:CHRYSALIS A. HEINKEL, DDS, PLLC
Entity type:Organization
Organization Name:CHRYSALIS A. HEINKEL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRYSALIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PLLC
Authorized Official - Phone:210-643-3494
Mailing Address - Street 1:11021 OLD CORPUS CHRISTI HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-9363
Mailing Address - Country:US
Mailing Address - Phone:210-633-0057
Mailing Address - Fax:
Practice Address - Street 1:11021 OLD CORPUS CHRISTI HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-9363
Practice Address - Country:US
Practice Address - Phone:210-633-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental