Provider Demographics
NPI:1689794117
Name:EDDY, CHRISTOPHER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:EDDY
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 1:1170 NILES CORTLAND RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3510
Mailing Address - Country:US
Mailing Address - Phone:330-652-4967
Mailing Address - Fax:330-652-3017
Practice Address - Street 1:1170 NILES CORTLAND RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3510
Practice Address - Country:US
Practice Address - Phone:330-652-4967
Practice Address - Fax:330-652-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice