Provider Demographics
NPI:1811104318
Name:CHRISTOPHER, JOHN D (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:CHRISTOPHER
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 1:77 TROY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1330
Mailing Address - Country:US
Mailing Address - Phone:518-472-1444
Mailing Address - Fax:518-463-3011
Practice Address - Street 1:77 TROY RD
Practice Address - Street 2:SUITE D
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1330
Practice Address - Country:US
Practice Address - Phone:518-472-1444
Practice Address - Fax:518-463-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0457641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice