Provider Demographics
NPI:1982771473
Name:FEARON, CHRISTOPHER G (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:FEARON
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:BUILDING 634 POSTAL LOOP 7500
Mailing Address - Street 2:US ARMY DENTAL CLINIC
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-7500
Mailing Address - Country:US
Mailing Address - Phone:907-384-3079
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 634, POSTAL LOOP 7500
Practice Address - Street 2:US ARMY DENTAL CLINIC
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-7500
Practice Address - Country:US
Practice Address - Phone:907-384-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD115FQMedicaid