Provider Demographics
NPI:1013080258
Name:STINES, CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:STINES
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0158
Mailing Address - Country:US
Mailing Address - Phone:517-223-9753
Mailing Address - Fax:517-223-9755
Practice Address - Street 1:717 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-7914
Practice Address - Country:US
Practice Address - Phone:517-223-9753
Practice Address - Fax:517-223-9755
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI722132OtherUNITED CONCORDIA
MI4824990Medicaid
MI1954701310OtherBLUECROSS BLUE SHIELD