Provider Demographics
NPI:1609843291
Name:PILGRIM, CHRISTIAN HEATH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:HEATH
Last Name:PILGRIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6067
Mailing Address - Country:US
Mailing Address - Phone:405-691-0836
Mailing Address - Fax:405-691-0480
Practice Address - Street 1:717 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6067
Practice Address - Country:US
Practice Address - Phone:405-691-0836
Practice Address - Fax:405-691-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
952606OtherUNITED CONCORDIA
OK200191730AMedicaid
1309163OtherUNITED CONCORDIA GROUP