Provider Demographics
NPI:1205940004
Name:CHRISTMAN, GARY MARVIN (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MARVIN
Last Name:CHRISTMAN
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 1:700 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5399
Mailing Address - Country:US
Mailing Address - Phone:360-876-3171
Mailing Address - Fax:360-876-3182
Practice Address - Street 1:700 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5399
Practice Address - Country:US
Practice Address - Phone:360-876-3171
Practice Address - Fax:360-876-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice