Provider Demographics
NPI:1326131723
Name:KITSON, CHRISTOPHER PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:KITSON
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 1:25517 NORTHERN BLVD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1453
Mailing Address - Country:US
Mailing Address - Phone:718-428-8024
Mailing Address - Fax:718-428-8024
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:718-937-6750
Practice Address - Fax:718-937-1830
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00963960Medicaid