Provider Demographics
NPI:1790700516
Name:AMMONS, CHRISTY DRUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:DRUM
Last Name:AMMONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5639
Mailing Address - Country:US
Mailing Address - Phone:337-478-0870
Mailing Address - Fax:337-478-0891
Practice Address - Street 1:214 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5639
Practice Address - Country:US
Practice Address - Phone:337-478-0870
Practice Address - Fax:337-478-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist