Healthcare Provider Details

I. General information

NPI: 1700981123
Provider Name (Legal Business Name): CHRISTOPHER J GUDGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 STANDONSHIRE WAY STE 121
RALEIGH NC
27615-2760
US

IV. Provider business mailing address

8351 STANDONSHIRE WAY STE 121
RALEIGH NC
27615-2760
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-8400
  • Fax: 919-846-8398
Mailing address:
  • Phone: 919-846-8400
  • Fax: 919-846-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7280
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: