Provider Demographics
NPI:1013021989
Name:WILEY, CHRISTOPHER B (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:WILEY
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:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-1108
Mailing Address - Country:US
Mailing Address - Phone:269-857-1496
Mailing Address - Fax:269-857-1497
Practice Address - Street 1:6515 BLUE STAR HIGHWAY
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-1108
Practice Address - Country:US
Practice Address - Phone:269-857-1496
Practice Address - Fax:269-857-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI143490122300000X
OH1434901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice