Provider Demographics
NPI:1740386150
Name:O'ROURKE, CHRISTOPHER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2837
Mailing Address - Country:US
Mailing Address - Phone:865-966-7732
Mailing Address - Fax:865-671-3301
Practice Address - Street 1:11226 W POINT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2837
Practice Address - Country:US
Practice Address - Phone:865-966-7732
Practice Address - Fax:865-671-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-42141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA595362OtherUNITED CONCORDIA
TN0142126OtherBLUE CROSS BLUE SHIELD