Provider Demographics
NPI:1629078001
Name:WHERTHEY, CHRISTOPHER PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:WHERTHEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 BLVD DE FRANCE
Mailing Address - Street 2:BLDG 674
Mailing Address - City:PARRIS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29905
Mailing Address - Country:US
Mailing Address - Phone:843-228-3500
Mailing Address - Fax:
Practice Address - Street 1:674 BOULEVARD DE FRANCE
Practice Address - Street 2:
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029937L1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101163184Medicaid