Healthcare Provider Details

I. General information

NPI: 1982965935
Provider Name (Legal Business Name): ..CHRIS NARVELLO ST HILLAIRE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MARMONT ST
NILES MI
49120-1657
US

IV. Provider business mailing address

8695 MEADOW LN
BERRIEN SPRINGS MI
49103-1426
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-6461
  • Fax:
Mailing address:
  • Phone: 269-815-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020217
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: