Provider Demographics
NPI:1811046287
Name:SABOURIN, CHRISTOPHER ROBERT (DDS, MS, MSD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:SABOURIN
Suffix:
Gender:M
Credentials:DDS, MS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 SHAW AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4044
Mailing Address - Country:US
Mailing Address - Phone:559-322-2054
Mailing Address - Fax:559-322-2056
Practice Address - Street 1:1829 SHAW AVE STE 104
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4044
Practice Address - Country:US
Practice Address - Phone:559-322-2054
Practice Address - Fax:559-322-2056
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics