Provider Demographics
NPI:1134387616
Name:PAUL S CHRISTIE III DDS PLC
Entity type:Organization
Organization Name:PAUL S CHRISTIE III DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-744-7484
Mailing Address - Street 1:2015 HOLTON RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-1535
Mailing Address - Country:US
Mailing Address - Phone:231-744-4784
Mailing Address - Fax:231-744-0601
Practice Address - Street 1:2015 HOLTON RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1535
Practice Address - Country:US
Practice Address - Phone:231-744-4784
Practice Address - Fax:231-744-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11281261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental