Provider Demographics
NPI:1235348749
Name:PIDHAJECKY, CHRISTOPHER WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WADE
Last Name:PIDHAJECKY
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 1:32 BEACH BLUFF TER
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2102
Mailing Address - Country:US
Mailing Address - Phone:207-619-7125
Mailing Address - Fax:
Practice Address - Street 1:347 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1338
Practice Address - Country:US
Practice Address - Phone:207-839-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052123-1122300000X
MEDEN4251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist