Provider Demographics
NPI:1720792815
Name:DINGESS, CHRISTIAN RAY (PRSS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:RAY
Last Name:DINGESS
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3966
Mailing Address - Country:US
Mailing Address - Phone:304-792-8689
Mailing Address - Fax:304-752-8891
Practice Address - Street 1:101 LOGAN ST.
Practice Address - Street 2:MEMORIAL BLDG BASEMENT
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-235-0426
Practice Address - Fax:304-235-2295
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22-9246175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist