Provider Demographics
NPI:1801039144
Name:CHRISTIE, CALLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CALLEY
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5450
Mailing Address - Country:US
Mailing Address - Phone:206-683-6473
Mailing Address - Fax:
Practice Address - Street 1:3602 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5450
Practice Address - Country:US
Practice Address - Phone:206-683-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604706321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery