Healthcare Provider Details

I. General information

NPI: 1750700837
Provider Name (Legal Business Name): CHRISTOPHER GURRIES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 2439
SAN FRANCISCO CA
94108-4208
US

IV. Provider business mailing address

633D MDG ORAL AND MAXILLOFACIAL SURGERY 77 NEALY AVE
LANGLEY AFB VA
23665
US

V. Phone/Fax

Practice location:
  • Phone: 415-956-6610
  • Fax: 415-956-6618
Mailing address:
  • Phone: 757-764-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number63526
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401416451
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number63526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: