Provider Demographics
NPI:1659611184
Name:MCKELLAR, CHRISTINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:MCKELLAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:101 S PLAYERS CLUB DR APT 20101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-5073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 ELM ST
Practice Address - Street 2:STE 301
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8233
Practice Address - Country:US
Practice Address - Phone:770-744-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry