Provider Demographics
NPI:1457327942
Name:THE DENTAL DEPOT CHRISTOPHER W FORD DDS
Entity Type:Organization
Organization Name:THE DENTAL DEPOT CHRISTOPHER W FORD DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-732-4740
Mailing Address - Street 1:3362 LENNON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1015
Mailing Address - Country:US
Mailing Address - Phone:810-732-4740
Mailing Address - Fax:810-732-4822
Practice Address - Street 1:3362 LENNON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1015
Practice Address - Country:US
Practice Address - Phone:810-732-4740
Practice Address - Fax:810-732-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID0121161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty