Provider Demographics
NPI:1639343023
Name:PUGEDA, CHRISTOPHER S (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:PUGEDA
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 1:728 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2429
Mailing Address - Country:US
Mailing Address - Phone:618-281-1888
Mailing Address - Fax:618-281-1889
Practice Address - Street 1:728 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1070
Practice Address - Country:US
Practice Address - Phone:618-281-1888
Practice Address - Fax:618-281-1889
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0253651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice