Provider Demographics
NPI:1134344807
Name:MADDOX, CHRISTOPHER JEREMY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JEREMY
Last Name:MADDOX
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 1:5630 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-4346
Mailing Address - Country:US
Mailing Address - Phone:513-574-7511
Mailing Address - Fax:513-574-8713
Practice Address - Street 1:5630 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-4346
Practice Address - Country:US
Practice Address - Phone:513-574-7511
Practice Address - Fax:513-574-8713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300204311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice