Provider Demographics
NPI:1548393416
Name:MAURY, CHRISTOPHER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:MAURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:J
Other - Last Name:MAURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:145 S MARR ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4434
Mailing Address - Country:US
Mailing Address - Phone:920-921-6260
Mailing Address - Fax:920-921-8099
Practice Address - Street 1:145 S MARR ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4434
Practice Address - Country:US
Practice Address - Phone:920-921-6260
Practice Address - Fax:920-921-8099
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5369-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist