Provider Demographics
NPI:1437463536
Name:CHRISTOPHER S. MILLSAPS DDS PA
Entity Type:Organization
Organization Name:CHRISTOPHER S. MILLSAPS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLSAPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-346-1930
Mailing Address - Street 1:7 CORPORATE CENTER CT STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3839
Mailing Address - Country:US
Mailing Address - Phone:336-346-1930
Mailing Address - Fax:336-346-1929
Practice Address - Street 1:7 CORPORATE CENTER CT STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3839
Practice Address - Country:US
Practice Address - Phone:336-346-1930
Practice Address - Fax:336-346-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910002Medicaid