Provider Demographics
NPI:1851788095
Name:BURCHETT, CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:BURCHETT
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 1:11631 DECATUR ST
Mailing Address - Street 2:L302
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2578
Mailing Address - Country:US
Mailing Address - Phone:907-654-5369
Mailing Address - Fax:
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6100
Practice Address - Country:US
Practice Address - Phone:907-654-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN 8515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK92-0038225Medicaid