Provider Demographics
NPI:1366494254
Name:MATHISON, CHRISTOPHER MARK (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:MATHISON
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 1:1616 30TH AV S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-233-4267
Mailing Address - Fax:218-233-3294
Practice Address - Street 1:1616 30TH AV S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-4267
Practice Address - Fax:218-233-3294
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist