MEDICARE: DR. CHRISTOPHER PAUL KITTLE DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6427	LA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	L476270	MI

General Provider Information

NPI Number	:	1437343829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER PAUL KITTLE DDS

Provider Business Mailing Address
First Line	:	7223 MISSISSIPPI AVENUE, BLDG #1561
Second Line	:	USA DENTAL ACTIVITY ATTN: CREDENTIALS COORDINATOR
City	:	FORT POLK
State	:	LA
Zip	:	71459-5110
Country	:	US
Telephone Number	:	337-531-2327
Fax Number	:	337-531-6356

Provider Business Practice Location Address
First Line	:	7223 MISSISSIPPI AVE, BLDG #1561
Second Line	:	ATTN: CREDENTIALS COORDINATOR
City	:	FORT POLK
State	:	LA
Zip	:	71459-5110
Country	:	US
Telephone Number	:	337-531-2327
Fax Number	:	337-531-6356

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	09/22/2015

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