Provider Demographics
NPI:1205809019
Name:FORD, CHRISTINE RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:RAE
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RAE
Other - Last Name:BLUMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3891 E PALO VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1861
Mailing Address - Country:US
Mailing Address - Phone:206-819-0447
Mailing Address - Fax:
Practice Address - Street 1:3891 E PALO VERDE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1861
Practice Address - Country:US
Practice Address - Phone:206-819-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice