Provider Demographics
NPI:1598751844
Name:ETTRICH, CHRISTOPHER ADOLF (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ADOLF
Last Name:ETTRICH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9773 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6947
Mailing Address - Country:US
Mailing Address - Phone:614-789-3636
Mailing Address - Fax:614-789-5797
Practice Address - Street 1:9773 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6947
Practice Address - Country:US
Practice Address - Phone:614-789-3636
Practice Address - Fax:614-789-5797
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-03361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics