Provider Demographics
NPI:1992848808
Name:DE LA MATER, CHRISTOPHER MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DE LA MATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3867 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2518
Mailing Address - Country:US
Mailing Address - Phone:763-586-0070
Mailing Address - Fax:763-586-0072
Practice Address - Street 1:3833 COON RAPIDS BLVD NW STE 220
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2597
Practice Address - Country:US
Practice Address - Phone:763-421-6271
Practice Address - Fax:763-421-6273
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND12752204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery