Healthcare Provider Details

I. General information

NPI: 1194826412
Provider Name (Legal Business Name): CHRISTOPHER R DYKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24840 GRATIOT AVE
EASTPOINTE MI
48021-3381
US

IV. Provider business mailing address

24840 GRATIOT AVE
EASTPOINTE MI
48021-3381
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-6340
  • Fax: 586-771-6383
Mailing address:
  • Phone: 586-771-6340
  • Fax: 586-771-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: