Provider Demographics
NPI:1710189584
Name:CHRISTOPHER J BOULDIN DDS
Entity Type:Organization
Organization Name:CHRISTOPHER J BOULDIN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-544-3723
Mailing Address - Street 1:1920 EAST HIGHWAY 54
Mailing Address - Street 2:SUITE 570
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2263
Mailing Address - Country:US
Mailing Address - Phone:919-544-3723
Mailing Address - Fax:919-484-8076
Practice Address - Street 1:1920 EAST HIGHWAY 54
Practice Address - Street 2:SUITE 570
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2263
Practice Address - Country:US
Practice Address - Phone:919-544-3723
Practice Address - Fax:919-484-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC5266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty