Provider Demographics
NPI:1700644663
Name:CHRISTIE, WINTERHAWK JAMES (RDH)
Entity Type:Individual
Prefix:
First Name:WINTERHAWK
Middle Name:JAMES
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 DIAMOND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5414
Mailing Address - Country:US
Mailing Address - Phone:530-605-6716
Mailing Address - Fax:
Practice Address - Street 1:81 ARBUCKLE COURT
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35162124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist