Provider Demographics
NPI:1912159302
Name:MATTHEW C. CHRISTOPHER DDS PC
Entity Type:Organization
Organization Name:MATTHEW C. CHRISTOPHER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-741-4565
Mailing Address - Street 1:715 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1100
Mailing Address - Country:US
Mailing Address - Phone:571-741-4565
Mailing Address - Fax:517-741-8912
Practice Address - Street 1:715 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1100
Practice Address - Country:US
Practice Address - Phone:571-741-4565
Practice Address - Fax:517-741-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124325837Medicaid