MEDICARE: CHRISTOPHER LEE GREENWALDT DMD

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	1223G0001X	General Practice Dentistry	1001283-15	WI
2	1223G0001X	General Practice Dentistry	019.030223	IL
3	1223E0200X	Endodontics	021.003451	IL

General Provider Information

NPI Number	:	1467849679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LEE GREENWALDT DMD

Provider Business Mailing Address
First Line	:	4218 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4620
Country	:	US
Telephone Number	:	312-607-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 BRYNWOOD DR STE 205
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-6579
Country	:	US
Telephone Number	:	815-201-5955
Fax Number	:

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

Provider Enumeration Date	:	04/26/2015
Last Update Date	:	08/25/2025

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