Provider Demographics
NPI:1023464112
Name:REHAGE, CHRISTOPHER JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:REHAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1907
Mailing Address - Country:US
Mailing Address - Phone:707-748-7600
Mailing Address - Fax:707-748-7693
Practice Address - Street 1:884 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1907
Practice Address - Country:US
Practice Address - Phone:707-748-7600
Practice Address - Fax:707-748-7693
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1004301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program