Provider Demographics
NPI:1629024369
Name:EBERT, CHRISTOPHER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:EBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AARON
Other - Middle Name:M
Other - Last Name:CARMEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:390 E HOWARD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1656
Mailing Address - Country:US
Mailing Address - Phone:419-935-2881
Mailing Address - Fax:419-933-0026
Practice Address - Street 1:390 E HOWARD ST
Practice Address - Street 2:SUITE C
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1656
Practice Address - Country:US
Practice Address - Phone:419-935-2881
Practice Address - Fax:419-933-0026
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0189631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice