Healthcare Provider Details

I. General information

NPI: 1194066167
Provider Name (Legal Business Name): CHRISTMAN DENTAL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W PRAIRIE VIEW ROAD
CHIPPEWA FALLS WI
54729-3389
US

IV. Provider business mailing address

425 W PRAIRIE VIEW ROAD
CHIPPEWA FALLS WI
54729-3389
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-1060
  • Fax:
Mailing address:
  • Phone: 715-726-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4080
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6466
License Number StateWI

VIII. Authorized Official

Name: DR. BLANE R CHRISTMAN
Title or Position: OWNER
Credential: DDS
Phone: 715-726-1060