Provider Demographics
NPI:1942374582
Name:DONALD, CHRISTOPHER MARK (D M D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:DONALD
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4420
Mailing Address - Country:US
Mailing Address - Phone:251-626-6869
Mailing Address - Fax:251-626-3868
Practice Address - Street 1:1281 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4420
Practice Address - Country:US
Practice Address - Phone:251-626-6869
Practice Address - Fax:251-626-3868
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice