Provider Demographics
NPI:1265445548
Name:CHRISTY, JOHN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:CHRISTY
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 1:63 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4945
Mailing Address - Country:US
Mailing Address - Phone:518-792-2187
Mailing Address - Fax:518-792-2188
Practice Address - Street 1:63 HUDSON ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4945
Practice Address - Country:US
Practice Address - Phone:518-792-2187
Practice Address - Fax:518-792-2188
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041463-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10033415OtherCDPHP
NY1408571OtherUNITED CONCORDIA
NY000456691002OtherBLUE SHIELD