Provider Demographics
NPI:1275661233
Name:JAGHAB, CHRISTOPHER GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:JAGHAB
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 1:5760 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1262
Mailing Address - Country:US
Mailing Address - Phone:248-855-4800
Mailing Address - Fax:
Practice Address - Street 1:5760 DRAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1262
Practice Address - Country:US
Practice Address - Phone:248-855-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI184291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4798325Medicaid