Provider Demographics
NPI:1821199605
Name:CHRISTIE, PHILLIP MC LEAN (DDS, MAGD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MC LEAN
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23149 CRESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-6013
Mailing Address - Country:US
Mailing Address - Phone:301-862-2994
Mailing Address - Fax:301-862-1981
Practice Address - Street 1:23192 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2401
Practice Address - Country:US
Practice Address - Phone:301-862-2231
Practice Address - Fax:301-862-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD93761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice