Provider Demographics
NPI:1093864720
Name:ROSE, CHRISTOPHER M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:ROSE
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:530 KINGS COUNTY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5954
Mailing Address - Country:US
Mailing Address - Phone:559-587-1402
Mailing Address - Fax:559-587-1466
Practice Address - Street 1:530 KINGS COUNTY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5954
Practice Address - Country:US
Practice Address - Phone:559-587-1402
Practice Address - Fax:559-587-1466
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA403901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics