Provider Demographics
NPI:1114584190
Name:DUNCAN, CHRISTIAN ELIJAH (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ELIJAH
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 JOHN PURDOM DR
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020
Mailing Address - Country:US
Mailing Address - Phone:270-556-9054
Mailing Address - Fax:
Practice Address - Street 1:706 MAIN ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1943
Practice Address - Country:US
Practice Address - Phone:270-753-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice