Provider Demographics
NPI:1619369592
Name:MACLAY, CHRISTINE ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MACLAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:ONDRIEZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS
Mailing Address - State:PA
Mailing Address - Zip Code:17578-9590
Mailing Address - Country:US
Mailing Address - Phone:717-366-3851
Mailing Address - Fax:
Practice Address - Street 1:1 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9590
Practice Address - Country:US
Practice Address - Phone:717-336-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040104122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103011637Medicaid