Provider Demographics
NPI:1023309366
Name:VANDERPOOL, CHRISTOPHER DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:VANDERPOOL
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 1:863 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-5033
Mailing Address - Country:US
Mailing Address - Phone:508-674-4556
Mailing Address - Fax:508-674-5360
Practice Address - Street 1:863 COUNTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-5033
Practice Address - Country:US
Practice Address - Phone:508-674-4556
Practice Address - Fax:508-674-5360
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559281223G0001X
RIDEN031421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice