Provider Demographics
NPI:1356305569
Name:CHRISTIAN, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:CHRISTIAN
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 1:875 UNION AVENUE
Mailing Address - Street 2:THE UNIVERSITY OF TENNESSEE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-3513
Mailing Address - Country:US
Mailing Address - Phone:901-448-6236
Mailing Address - Fax:901-448-5480
Practice Address - Street 1:875 UNION AVENUE
Practice Address - Street 2:THE UNIVERSITY OF TENNESSEE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6236
Practice Address - Fax:901-448-5480
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021966204E00000X
MD140571223S0112X
TNDS00000090881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526270Medicaid
MDKR83Medicare PIN
OH2526270Medicaid