Provider Demographics
NPI:1225111073
Name:CRONIN, CHRISTOPHER KELLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KELLY
Last Name:CRONIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:KELLY
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:68 OLD AIRPORT RD.
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-0000
Practice Address - Country:US
Practice Address - Phone:601-583-4800
Practice Address - Fax:601-584-7769
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42051223G0001X
MS3348-051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice