Provider Demographics
NPI:1922239433
Name:MANDUZZI, CHRISTOPHER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:MANDUZZI
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 1:7811 SUMMERS ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5559
Mailing Address - Country:US
Mailing Address - Phone:586-731-9240
Mailing Address - Fax:586-731-4688
Practice Address - Street 1:7811 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5559
Practice Address - Country:US
Practice Address - Phone:586-731-9240
Practice Address - Fax:586-731-4688
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice