Healthcare Provider Details

I. General information

NPI: 1679684070
Provider Name (Legal Business Name): CHRISTOPHER HANS HENRY DMD MS PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 PROSPERITY LAKE DR STE 301
ST AUGUSTINE FL
32092-5045
US

IV. Provider business mailing address

491 PROSPERITY LAKE DR STE 301
ST AUGUSTINE FL
32092-5045
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-0095
  • Fax: 904-429-0238
Mailing address:
  • Phone: 904-429-0095
  • Fax: 904-429-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1099
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberAA1099
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN22375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: