Provider Demographics
NPI:1437343829
Name:KITTLE, CHRISTOPHER PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:KITTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 MISSISSIPPI AVENUE, BLDG #1561
Mailing Address - Street 2:USA DENTAL ACTIVITY ATTN: CREDENTIALS COORDINATOR
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-5110
Mailing Address - Country:US
Mailing Address - Phone:337-531-2327
Mailing Address - Fax:337-531-6356
Practice Address - Street 1:7223 MISSISSIPPI AVE, BLDG #1561
Practice Address - Street 2:ATTN: CREDENTIALS COORDINATOR
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5110
Practice Address - Country:US
Practice Address - Phone:337-531-2327
Practice Address - Fax:337-531-6356
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64271223S0112X
MIL4762701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery