Healthcare Provider Details

I. General information

NPI: 1235348749
Provider Name (Legal Business Name): CHRISTOPHER WADE PIDHAJECKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MAIN ST
GORHAM ME
04038-1338
US

IV. Provider business mailing address

32 BEACH BLUFF TER
CAPE ELIZABETH ME
04107-2102
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-3006
  • Fax:
Mailing address:
  • Phone: 207-619-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number052123-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4251
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: