Provider Demographics
NPI:1285665216
Name:BOULDIN, CHRISTOPHER JAMES
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:BOULDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 EAST HIGHWAY 54
Mailing Address - Street 2:SUITE 570
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2263
Mailing Address - Country:US
Mailing Address - Phone:919-544-3723
Mailing Address - Fax:919-484-8076
Practice Address - Street 1:1920 EAST HIGHWAY 54
Practice Address - Street 2:SUITE 570
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2263
Practice Address - Country:US
Practice Address - Phone:919-544-3723
Practice Address - Fax:919-484-8076
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC5266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist