Provider Demographics
NPI:1912039769
Name:MCTAVISH, CHRISTOPHER JOSEPH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:MCTAVISH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3500 CAMPUS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7922
Mailing Address - Country:US
Mailing Address - Phone:301-874-0080
Mailing Address - Fax:
Practice Address - Street 1:3500 CAMPUS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7922
Practice Address - Country:US
Practice Address - Phone:301-874-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics