Provider Demographics
NPI:1376640532
Name:GULLICK, CHRISTOPHER BAIRD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BAIRD
Last Name:GULLICK
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 1:43625 MISSION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5852
Mailing Address - Country:US
Mailing Address - Phone:510-438-9177
Mailing Address - Fax:
Practice Address - Street 1:43625 MISSION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5852
Practice Address - Country:US
Practice Address - Phone:510-438-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist