Provider Demographics
NPI:1124695358
Name:URRUTIA, CRISTOBAL NICOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:NICOLAS
Last Name:URRUTIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 LENNOX FLATS DR APT 1574
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1485
Mailing Address - Country:US
Mailing Address - Phone:936-537-6700
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE RM 2051
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-688-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0043541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice