Provider Demographics
NPI:1396818654
Name:GANFIELD, CHRISTINA CHEW (BDS MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CHEW
Last Name:GANFIELD
Suffix:
Gender:F
Credentials:BDS MS
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:BOONE WUI
Other - Last Name:CHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:21 NE FRONTAGE RD
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920
Mailing Address - Country:US
Mailing Address - Phone:507-775-6445
Mailing Address - Fax:507-775-6446
Practice Address - Street 1:21 NE FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920
Practice Address - Country:US
Practice Address - Phone:507-775-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist