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NPI Code Detail

MEDICARE: JEBEDIAH S. CHRISTY, D.D.S., PC

MEDICARE: JEBEDIAH S. CHRISTY, D.D.S., PC
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
11223G0001XGeneral Practice Dentistry3540NH

General Provider Information

NPI Number : 1922284132
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEBEDIAH S. CHRISTY, D.D.S., PC
Provider Business Mailing Address
First Line : PO BOX 3189
Second Line :
City : SYRACUSE
State : NY
Zip : 13220-3189
Country : US
Telephone Number : 315-454-6000
Fax Number : 315-454-8650
Provider Business Practice Location Address
First Line : 448 WEST ST
Second Line :
City : KEENE
State : NH
Zip : 03431-2453
Country : US
Telephone Number : 603-352-0502
Fax Number : 603-352-2306
Authorized Official
Title or Position : OWNER
Name : DR. JEBEDIAH S CHRISTY
Credential : DDS
Telephone Number : 603-352-0502
Provider Enumeration Date : 01/17/2008
Last Update Date : 01/17/2008

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