Provider Demographics
NPI:1396828380
Name:PHELPS, CHRISTOPHER LATHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LATHAM
Last Name:PHELPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5353
Mailing Address - Country:US
Mailing Address - Phone:704-845-1107
Mailing Address - Fax:704-845-1370
Practice Address - Street 1:510 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5353
Practice Address - Country:US
Practice Address - Phone:704-845-1107
Practice Address - Fax:704-845-1370
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist