Provider Demographics
NPI:1114081486
Name:CHRISTY, TODD RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RICHARD
Last Name:CHRISTY
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 1:8383 M 139
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9001
Mailing Address - Country:US
Mailing Address - Phone:269-471-4055
Mailing Address - Fax:269-471-3829
Practice Address - Street 1:8383 M 139
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9001
Practice Address - Country:US
Practice Address - Phone:269-471-4055
Practice Address - Fax:269-471-3829
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist