Provider Demographics
NPI:1124228242
Name:EGEDE, CHRISTOPHER EDOBOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDOBOR
Last Name:EGEDE
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 1:5436 MONTAGUE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2695
Mailing Address - Country:US
Mailing Address - Phone:214-443-9404
Mailing Address - Fax:214-443-9401
Practice Address - Street 1:4501 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1830
Practice Address - Country:US
Practice Address - Phone:214-443-9404
Practice Address - Fax:214-443-9401
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice