Provider Demographics
NPI:1649654898
Name:ISABELLE, CHRISTOPHER R (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:ISABELLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S MICHIGAN AVE
Mailing Address - Street 2:UNIT 716
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1281
Mailing Address - Country:US
Mailing Address - Phone:708-415-6507
Mailing Address - Fax:
Practice Address - Street 1:1605 S MICHIGAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1209
Practice Address - Country:US
Practice Address - Phone:312-624-8913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist