Provider Demographics
NPI:1770155574
Name:KLUG, CHRISTINA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KLUG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 WASHINGTON PIKE STE 1107
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1461
Mailing Address - Country:US
Mailing Address - Phone:412-221-9440
Mailing Address - Fax:412-221-1377
Practice Address - Street 1:3249 WASHINGTON PIKE STE 1107
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1461
Practice Address - Country:US
Practice Address - Phone:412-221-9440
Practice Address - Fax:412-221-1137
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS043253OtherDENTAL
PADS043253OtherDDS