Provider Demographics
NPI:1679860209
Name:DAUTERIVE, CHRISTOPHER DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:DAUTERIVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 BARKER CYPRESS RD
Mailing Address - Street 2:STE 600
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6858
Mailing Address - Country:US
Mailing Address - Phone:832-334-5376
Mailing Address - Fax:832-653-6530
Practice Address - Street 1:11510 BARKER CYPRESS RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1216
Practice Address - Country:US
Practice Address - Phone:832-334-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist