Provider Demographics
NPI:1891895710
Name:CHRISTOPHER, DEBORAH DAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:DAVIS
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1640
Mailing Address - Country:US
Mailing Address - Phone:507-847-3317
Mailing Address - Fax:507-847-3995
Practice Address - Street 1:302 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1640
Practice Address - Country:US
Practice Address - Phone:507-847-3317
Practice Address - Fax:507-847-3995
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND103911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52135CHOtherBCBS OF MN
MN784387OtherUNITED CONCORDIA