Provider Demographics
NPI:1295783298
Name:LEA, CHRISTOPHER S (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:LEA
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 1:460 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4308
Mailing Address - Country:US
Mailing Address - Phone:912-756-5960
Mailing Address - Fax:912-756-5964
Practice Address - Street 1:10220 FORD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8825
Practice Address - Country:US
Practice Address - Phone:912-756-5960
Practice Address - Fax:912-756-5964
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ048431223E0200X
GADN0130791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics