Provider Demographics
NPI:1326161456
Name:GOLIS, CHRISTINE ANN (DDS,)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:GOLIS
Suffix:
Gender:F
Credentials:DDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COLLIS LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2202
Mailing Address - Country:US
Mailing Address - Phone:908-879-1933
Mailing Address - Fax:908-879-1935
Practice Address - Street 1:32 COLLIS LANE
Practice Address - Street 2:SUITE C
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2202
Practice Address - Country:US
Practice Address - Phone:908-879-1933
Practice Address - Fax:908-879-1935
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ212331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics