Provider Demographics
NPI:1851466007
Name:ROOT, CHRISTOPHER M (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:ROOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7233
Mailing Address - Country:US
Mailing Address - Phone:719-291-4749
Mailing Address - Fax:
Practice Address - Street 1:3630 AUSTIN BLUFFS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6663
Practice Address - Country:US
Practice Address - Phone:719-304-5400
Practice Address - Fax:719-304-5409
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1851466007Medicaid
CODEN.00007761OtherCO DENTAL LICENSE