Provider Demographics
NPI:1275108169
Name:MARSH, CHRISTOPHER CONRAD (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CONRAD
Last Name:MARSH
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 1:130 NAVAJO DR.
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336
Mailing Address - Country:US
Mailing Address - Phone:928-282-3246
Mailing Address - Fax:918-310-1056
Practice Address - Street 1:130 NAVAJO
Practice Address - Street 2:
Practice Address - City:SENDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336
Practice Address - Country:US
Practice Address - Phone:928-282-3246
Practice Address - Fax:417-781-8771
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist