Provider Demographics
NPI:1801469192
Name:MALZ, CHRISTOPHER R
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:MALZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 24TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1437
Mailing Address - Country:US
Mailing Address - Phone:612-659-8689
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1437
Practice Address - Country:US
Practice Address - Phone:612-659-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist