Provider Demographics
NPI:1891927679
Name:CHRISTLINE, CODY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:LEE
Last Name:CHRISTLINE
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 1:219 EARHART CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4739
Mailing Address - Country:US
Mailing Address - Phone:402-499-5201
Mailing Address - Fax:
Practice Address - Street 1:219 EARHART CIR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4739
Practice Address - Country:US
Practice Address - Phone:402-499-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery