Provider Demographics
NPI:1073305017
Name:CHRISTOPHER GREENWALDT, DMD, P.C.
Entity type:Organization
Organization Name:CHRISTOPHER GREENWALDT, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREENWALDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-607-8106
Mailing Address - Street 1:765 W ADAMS ST APT 1007
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3500
Mailing Address - Country:US
Mailing Address - Phone:312-607-8106
Mailing Address - Fax:
Practice Address - Street 1:6050 BRYNWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6579
Practice Address - Country:US
Practice Address - Phone:815-201-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-17
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty