Provider Demographics
NPI:1902837206
Name:ROOT, CHRISTOPHER JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:ROOT
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 1:82 RIVERVALE RD
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03779-3106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 OLD ETNA RD
Practice Address - Street 2:SUITES N1 AND N2
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1933
Practice Address - Country:US
Practice Address - Phone:603-448-3800
Practice Address - Fax:603-448-0553
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303859Medicaid