Healthcare Provider Details

I. General information

NPI: 1942374582
Provider Name (Legal Business Name): CHRISTOPHER MARK DONALD D. M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 MAIN ST
DAPHNE AL
36526-4420
US

IV. Provider business mailing address

1281 MAIN ST
DAPHNE AL
36526-4420
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-6869
  • Fax: 251-626-3868
Mailing address:
  • Phone: 251-626-6869
  • Fax: 251-626-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5071
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: