MEDICARE: DR. SCOTT T CHRISTIAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-025480	IL

General Provider Information

NPI Number	:	1427348143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT T CHRISTIAN D.D.S.

Provider Business Mailing Address
First Line	:	9220 E PRAIRIE RD
Second Line	:	#209
City	:	EVANSTON
State	:	IL
Zip	:	60203-1642
Country	:	US
Telephone Number	:	708-602-7892
Fax Number	:

Provider Business Practice Location Address
First Line	:	1149 WEILAND RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-7006
Country	:	US
Telephone Number	:	847-634-4773
Fax Number	:	847-634-6562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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