Provider Demographics
NPI:1922059906
Name:CHRISTOPHE, JOHN WENDELL (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WENDELL
Last Name:CHRISTOPHE
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 1:33 STATE ST UNIT 3E
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5038
Mailing Address - Country:US
Mailing Address - Phone:303-507-1287
Mailing Address - Fax:
Practice Address - Street 1:23 WABANAKI WAY
Practice Address - Street 2:
Practice Address - City:INDIAN ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04468-1252
Practice Address - Country:US
Practice Address - Phone:254-965-2810
Practice Address - Fax:254-965-5440
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612169431223G0001X
WI4741-0151223G0001X
CO93071223G0001X
TX208001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275830390Medicaid