Provider Demographics
NPI:1578133377
Name:CHRISTOPHER TRAXTER, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER TRAXTER, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-363-5534
Mailing Address - Street 1:761 GARDEN VIEW CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-944-7844
Mailing Address - Fax:
Practice Address - Street 1:761 GARDEN VIEW CT
Practice Address - Street 2:SUITE 102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-944-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty