Provider Demographics
NPI:1275621427
Name:DALIS, CHRIS PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:PETER
Last Name:DALIS
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 1:1122 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2026
Mailing Address - Country:US
Mailing Address - Phone:310-783-0428
Mailing Address - Fax:310-378-5486
Practice Address - Street 1:1122 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2026
Practice Address - Country:US
Practice Address - Phone:310-783-0428
Practice Address - Fax:310-378-5486
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice