Provider Demographics
NPI:1063503548
Name:PROCTOR, CHRISTOPHER WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:PROCTOR
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 1:1226 SAYLES BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4204
Mailing Address - Country:US
Mailing Address - Phone:325-673-6676
Mailing Address - Fax:
Practice Address - Street 1:4601 BUFFALO GAP RD
Practice Address - Street 2:SUITE C-4
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3375
Practice Address - Country:US
Practice Address - Phone:325-692-2423
Practice Address - Fax:325-692-2076
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice