Provider Demographics
NPI:1942540661
Name:MCCALL, CHRISTINE LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1663 OLD 122 RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9499
Mailing Address - Country:US
Mailing Address - Phone:937-901-8608
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-7543
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-011884124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist