Provider Demographics
NPI:1962848473
Name:DR. TOM CHRISTIE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:DR. TOM CHRISTIE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-825-2941
Mailing Address - Street 1:2628 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1803
Mailing Address - Country:US
Mailing Address - Phone:765-825-2941
Mailing Address - Fax:765-827-5796
Practice Address - Street 1:2628 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1803
Practice Address - Country:US
Practice Address - Phone:765-825-2941
Practice Address - Fax:765-827-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100129090B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty