Provider Demographics
NPI:1598014524
Name:SMITH, CHRISTOPHER M I (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:SMITH
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1249 SHACKAMAXON ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1512
Practice Address - Country:US
Practice Address - Phone:610-544-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0408111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery